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A 30-year-old man with no significant medical history presented with worsening of lower abdominal discomfort and a weight loss of 70 pounds during the past 6 months. Physical examination was significant for a large, firm, non-tender, irregular mass in the lower abdomen, more prominent on the left of the midline, and a small-sized non-tender swelling of the right testicle. Lactate dehydrogenase was 1562 U/L (135–225 U/L), uric acid 8.2 mg/dL (3.4–7.0 mg/dL), serum ß-human chorionic gonadotropin (HCG) 85 mIU/mL and alpha-fetoprotein (AFP) 1.3 ng/mL (0.0–9.0 ng/mL). CT scan of the abdomen and pelvis showed a large retroperitoneal mass encasing the abdominal aorta and its branching (figure 1A) and compressing the inferior vena cava (figures 1B, C and 2). Testicular ultrasound (US) showed a small right testicular mass with internal vascularity (figure 3A, B). The patient underwent right-sided orchiectomy …