Diagnosis: Combined testicular tumor: seminoma + embryonal carcinoma + yolk sac tumor + syncitiotrophoblast cells + vascular invasion.    

            Comment: The presence of syncitiotrophoblast cells may be exuberant as in this case including hemorrhage (Fig.4). This finding should not be misdiagnosed as choriocarcinoma. Fig. 5 shows vascular invasion which is an important finding in the testis because affects staging (pT2). Note that the intravascular tumor conforms to the shapes of the vessels helping in the diagnosis with artifactual presence of tumoral cells. Fig. 1 shows seminoma, Fig. 2 embryonal carcinoma, and Fig. 3 yolk sac tumor.