The most common presentation of testicular cancers is a painless and firm testicular mass. However in 20–27 % of cases, the first symptom is scrotal pain [1] caused by the stretching of the tunica albuginea by intratumour infarction or haemorrhage from a rapidly growing vascular tumour. This presentation is more common with NSGCTs than with seminoma. Occasionally, trauma to the scrotum may incidentally bring into attention the presence of a testicular mass. In about 10 % of cases, a testicular tumour can mimic epididymo–orchitis, with consequent delay of the correct diagnosis.

Approximately 7 % of men with testicular cancer have gynaecomastia resulting from either elevated serum HCG levels, decreased androgen production or increased oestrogen [1]. About 30 % of patients with Leydig and Sertoli cell tumours have gynaecomastia [2]. Subfertility is found in a large proportion of men with GCT and occasionally can be the main complaint at presentation.

While only approximately 15 % of pure seminomas present with regional or distant metastasis, as much as 2/3 of NSGCTs are reported to be diagnosed in the advanced stages and 10–20 % present with symptoms consistent with metastatic disease [3]. Compression of the ureters, psoas muscle or nerve roots by bulky retroperitoneal metastases can cause flank and back pain which was reported to occur in about 11 % of cases [4]. Oedema of the lower extremity may also occur when there is compression of the inferior vena cava. Pulmonary and mediastinal metastasis may present by dyspnea, chest pain, cough or hemoptysis.