Late relapse of GCT is defined as follows:

• Initial diagnosis of seminomatous or nonse-minomatous testicular GCT.

• Recurrence of GCT established by biopsy, marker elevation, or growth at a previously stable GCT site.

• Interval of more than 2 years since successful treatment of the initial GCT.

* Corresponding author. Department of Urology, Rabin Medical Center, Beilinson Campus, Petah Tikva 49100, Israel.

E-mail address: [email protected] (J. Baniel).

To establish the diagnosis, the presence of a second primary testicular neoplasm or extra-gonadal GCT and secondary causes of marker elevation should be excluded. Physical examination and ultrasound of the remaining testicle are of major importance. A false-positive elevation of beta-human chorionic gonadotropin (HCG) can occur from cross-reaction of substances such as marijuana or luteinizing hormone (LH). LH is elevated in hypogonadism, and may be reduced in these cases by administration of testosterone. A false-positive elevation of alpha-fetoprotein (AFP) can occur in association with liver disease or drug abuse (alcohol or cocaine).

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