The records of 636 patients who were treated for carcinoma of the test
is were reviewed. Of these patients, 61 (9.6 percent) presented with e
xtratesticular complaints. In order of decreasing frequency, the compl
aints were pain (abdominal, back or groin), gynecomastia or mastodynia
, pulmonary complaints, enlarged lymph nodes or a nontesticular mass,
swelling of the lower extremity or neurologic changes. A substantial n
umber of these patients were initially misdiagnosed and underwent a su
rgical procedure. Of importance, most of these patients had either abn
ormal testicular examination results, elevated markers or a history of
cryptorchidism. The data suggest that patients with germ cell tumors,
even when presenting with cryptic complaints, can readily be diagnose
d if a high level of suspicion is maintained, a careful testicular exa
mination is performed and tumor markers obtained. This frequently make
s a diagnostic abdominal exploration or other surgical interventions u
nnecessary.