Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease by John Cunningham virus (JC virus) infection in oligodendrocytes. The radiographic and clinical features, along with the identification JC in cerebrospinal fluid polymerase chain reaction, are sufficient for the diagnosis of PML in immunodeficiency. However, it is difficult to suspect PML without the patient history of immunodeficiency. A 32-year-old man presented with headache for a month without any medical history. Based on clinical and image features, the differential diagnoses included demyelinating lesion and neoplasms. Microscopically, biopsy specimen showed multifocal demyelinating and degenerative white matter, consistent with PML. Oligodendrocytes cells with increased nuclei and plum-colored inclusions were admixed with perivascular lymphocytic and histiocytic infiltration, and loss of myelin. Atypical astrocytes had large or multiple nuclei. After brain biopsy, human immunodeficiency virus infection was confirmed by serum chemiluminescent immunoassay. It is unlikely that PML would be considered without the information of immunosuppression. Therefore, it is very important to be aware of the histological features of PML.

Testicular germ cell tumors (GCT) arise from embryonic or extraembryonic differentiated totipotential germ cells. The tumor cells can differentiate into germ cells as well as, other lineages including yolk sac tumors, choriocarcinomas, and teratomas. Mixed GCT is composed of more than one GCT component including one or more nonseminomatous elements in a tumor, accounting for one-third of GCT. Herein we report the case of a collision tumor with two distinct and separated GCTs in the testis, adjacent to each other. A 48-year-old, previously healthy man showed the hard swelling and heterogeneous enhancing mass in the right scrotum, and right orchiectomy was performed. Grossly, the lesion was two distinct and well-circumscribed masses in the testis. Microscopically, a larger tumor was immature teratoma (prepubertal type) and another smaller tumor was seminoma. These two tumors can be from a common precursor, germ cell neoplasia in situ (GCNIS); however, they are two distinct pathological entities. Given that teratomas can evolve from seminomas by additional genetic alterations, seminomas are also a precursor for postpubertal-type teratomas. Two distinct GCNISs may occur at different times. Because GCNIS is patchy distributed, a close gross examination must be performed in GCNIS or GCT to miss other GCTs with poor prognosis and to prevent under-treatment.