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.

Abstract
INTRODUCTION
CASE REPORT
DISCUSSION
REFERENCES

• Chang Gok Woo(Department of Pathology, Chungbuk National University Hospital, Cheongju 28644, Korea)
• Ok-Jun Lee(Department of Pathology, Chungbuk National University Hospital, Cheongju 28644, Korea,Department of Pathology, College of Medicine, Chungbuk National University, Cheongju 28644, Korea) Corresponding author