Orbital metastasis of choriocarcinoma from a testicular malignant germ cell tumor: A late unfavorable prognostic sign

A 43-year-old man presented with a painful left proptosis 6 years after he had had orchiectomy for a mixed germ cell tumor. He also previously developed pulmonary and brain metastases, which were treated with chemotherapy and radiotherapy. Magnetic resonance imaging studies revealed an irregular mass confined to the left superior orbit. The neoplastic cells stained positive for human placental lactogen and sal-like protein 4 but negative for Alpha fetoprotein (AFP), CD30, and octamer binding transcription factor 3/4, compatible with metastatic choriocarcinoma. A painful mass located in the superior orbit in a young man must arouse the suspicion for a metastatic testicular carcinoma.