a = new Array(174);
var f = "<FONT FACE=ARIAL SIZE=2>"
a[0] = ""
a[1] = f + "(A) CORRECT. Such a 'Sertoli cell only' syndrome is a cause for male infertility. A similar pattern would be present in a cryptorchid testis."
a[2] = f + "(B) Incorrect. An elevated HCG in a male suggests the presence of testicular choriocarcinoma."
a[3] = f + "(C) Incorrect. LH acts on the Leydig cells of the testicular interstitium, which are generally unaffected by processes that reduce the numbers of germ cells."
a[4] = f + "(D) Incorrect. The Leydig cells of the testicular interstitium continue to function. He does not have loss of secondary sex characteristics."
a[5] = f + "(E) Incorrect. MIF is a hormone active in embryogenesis of males which controls testicular descent in the first abdominal phase, causing the testes to come to lie low in the abdomen, in the second stage of descent the testes descend under control of androgens down the inguinal canals to the scrotum."
a[5.1] = f + "(F) Incorrect. An elevation of AFP suggests the presence of a testicular neoplasm with a yolk sac element."
a[6] = f + "(A) Incorrect. Choriocarcinomas are very aggressive tumors. A high HCG would suggest a component of choriocarcinoma."
a[7] = f + "(B) Incorrect. This tumor does not respond as well to chemotherapy as seminoma. A high AFP would suggest embryonal carcinoma or yolk sac carcinoma."
a[8] = f + "(C) CORRECT. The most common pure form of testicular cancer is seminoma, which is radiosensitive. The tumor markers are not markedly elevated. This form of testicular carcinoma has the best prognosis overall, when not mixed with other elements."
a[9] = f + "(D) Incorrect. This is the most common testicular neoplasm in males under age 3. In adults, yolk sac elements are mixed with embryonal carcinoma."
a[10] = f + "(E) Incorrect. Leydig cell tumors are not common. This benign tumor is usually small in size."
a[11] = f + "(A) Incorrect. The testis has been out of place too long to retain any function of spermatogenesis. It is now atrophic with few remaining germ cells and minimal, if any, spermatogenesis occurring."
a[12] = f + "(B) Incorrect. The opposite testis will not be affected by the cryptorchid testis."
a[13] = f + "(C) CORRECT. A cryptorchid testis that is not treated in early childhood no longer functions and presents a risk for subsequent development of seminoma. The earlier in life that an orchiopexy is performed, generally under the age of 5, the more likely the testis will function properly"
a[14] = f + "(D) Incorrect. The patient still has one good testis. Even with bilateral cryptorchidism, the Leydig cells of the testicular interstitium continue to function and produce testosterone."
a[15] = f + "(E) Incorrect. If this were testicular feminization with androgen insensitivity, the phenotype would be female. If he were Klinefelter's, the testes would be small and in the scrotum."
a[16] = f + "(A) CORRECT. Such a nodule at that age strongly suggests carcinoma. Most carcinomas of the prostate arise in the posterior portion where they can be palpated on digital rectal examination. Microscopically, prostatic adenocarcinomas have irregular glands without intervening stroma. Large nucleoli are a characteristic microscopic feature."
a[17] = f + "(B) Incorrect. Hyperplasia is usually not a focal process, and the glands are not small and crowded."
a[18] = f + "(C) Incorrect. Inflammation is usually not focal in the prostate."
a[19] = f + "(D) Incorrect. This would be an unusual pattern of metastasis. Transitional cell carcinomas do not appear glandular."
a[20] = f + "(E) Incorrect. The glands around an infarct may show squamous metaplasia, but they will not be small and crowded."
a[21] = f + "(A) CORRECT. The chronic irritation from accumulation of secretions and smegma under the prepuce is the likely reason."
a[22] = f + "(B) Incorrect. Although herpes can be a recurrent infection, it is not premalignant."
a[23] = f + "(C) Incorrect. This is an eczematous dermatitis that is not premalignant."
a[24] = f + "(D) Incorrect. This manifestation of lichen simplex may result in stricture of the urethral meatus."
a[25] = f + "(E) Incorrect. This congenital condition results in a groove or a cleft on the dorsum of the penis into which the urethra opens."
a[26] = f + "(A) Incorrect. A strain of C. trachomatis can produce lymphogranuloma venereum."
a[27] = f + "(B) CORRECT. HPV produces genital warts and cancers, but not typically ulcers."
a[28] = f + "(C) Incorrect. This organism produces the chronic ulcers of granuloma inguinale."
a[29] = f + "(D) Incorrect. Syphilis produces chancres."
a[30] = f + "(E) Incorrect. This organism produces the acute ulceration of chancroid."
a[30.1] = f + "(F) Incorrect. Herpetic lesions usually start out as vesicles, but they often burst to leave shallow, painful ulcers."
a[31] = f + "(A) Incorrect. A hydrocele may produce an enlargement that has smooth borders. Hydroceles generally do not affect the sperm count."
a[32] = f + "(B) Incorrect. Torsion is an acute emergency because the arterial blood supply to the testis is cut off."
a[33] = f + "(C) Incorrect. A spermatocele is usually a small circumscribed mass and does not affect the sperm count."
a[34] = f + "(D) CORRECT. The increased warmth from the vascularity reduces sperm production. Spermatogenesis needs to occur at a temperature below that of the body as a whole, which explains why testes are in the scrotum."
a[35] = f + "(E) Incorrect. A seminoma usually produces a firm mass lesion."
a[36] = f + "(A) Incorrect. An adenocarcinoma is more likely to be associated with a greater increase in the PSA level, and a carcinoma is more likely to be palpated as a firm nodule."
a[37] = f + "(B) Incorrect. Acute prostatitis can increase the PSA slightly and can produce some enlargment and pain, but his problem has persisted for several years."
a[38] = f + "(C) Incorrect. Infarction of the prostate is not common, but can increase the PSA slightly. However, his problem has persisted for several years."
a[39] = f + "(D) CORRECT. BPH is a common finding in older males. The lateral lobes are typically involved (in contrast to carcinomas which are most often found in the posterior lobe), and the increasing prostatic urethral obstruction leads to the classic symptoms of frequency and hesitancy with urination. The PSA can be mildly elevated with hyperplasia, but the level tends not to increase significantly over time."
a[40] = f + "(E) Incorrect. Granulomatous diseases are rare in the prostate."
a[41] = f + "(A) Incorrect. Testicular neoplasms have a peak incidence in young adult males, not children."
a[42] = f + "(B) Incorrect. This lesion does not typically produce sudden pain."
a[43] = f + "(C) Incorrect. Urinary tract lithiasis is more typical in adults."
a[44] = f + "(D) CORRECT. This condition often has a sudden onset and you must recognize this condition, because it must be treated immediately, for the lack of blood flow can lead to hemorrhagic infarction. An ultrasound can be used to help identify this condition, demonstrating lack of blood flow."
a[45] = f + "(E) Incorrect. A hydrocele slowly enlarges; such a lesion is more typical in adults."
a[46] = f + "(A) Incorrect. This is a complication of tertiary syphilis."
a[47] = f + "(B) Incorrect. Gonorrhea tends to involve the urethra and epididymis and not the overlying skin."
a[48] = f + "(C) CORRECT. When the testis is involved by gonorrhea, it is typically the epididymis. Many male gonorrheal infections are asymptomatic and not followed by significant complications. Urethritis with stricture is a possible complication."
a[49] = f + "(D) Incorrect. The tubules and interstitium of the testis are typically not involved by gonorrhea, and infertility is unlikely."
a[50] = f + "(E) Incorrect. Sacroiliitis is most often a feature of the spondyloarthropathies such as ankylosing spondylitis, or even Reiter syndrome resulting from a non-gonococcal urethritis such as <I>Chlamydia trachomatis</I> infection."
a[51] = f + "(A) Incorrect. A pure teratoma in the testis is very uncommon. Usually a malignant component such as embryonal carcinoma is present."
a[52] = f + "(B) CORRECT. The embryonal carcinoma is likely to have an elevated AFP. Many malignant testicular neoplasms produce some detectable HCG, but this does not mean that choriocarcinoma is present."
a[53] = f + "(C) Incorrect. Mumps orchitis may produce some residual patchy tubular atrophy of no real significance."
a[54] = f + "(D) Incorrect. Leydig cell tumors are not common. Most are small brown masses."
a[55] = f + "(E) Incorrect. Squamous cell carcinomas do not arise in the testis."
a[55.1] = f + "(F) Incorrect. Choriocarcinomas have primitive appearing syncytiotrophoblastic cells in sheets with abundant hemorrhage. The HCG level is typically quite high."
a[56] = f + "(A) Incorrect. PIN is not life-threatening, but a precursor to prostatic adenocarcinoma that may require therapy later."
a[57] = f + "(B) Incorrect. PIN can lead to prostate cancer later, but is not a condition that is treated."
a[58] = f + "(C) Incorrect. PIN, by itself does not produce enlargement or nodules and does not warrant therapy. It may be found focally in the 'chips' from a TUR that was done for obstruction."
a[59] = f + "(D) CORRECT. PIN is a potential precursor of prostatic adenocarcinoma, but by itself does not warrant therapy."
a[60] = f + "(E) Incorrect. PIN is a precursor to prostate cancer and should not be completely ignored."
a[61] = f + "(A) Incorrect. This lesion appears in conjunction with human papillomavirus infection."
a[62] = f + "(B) Incorrect. A hard chancre appears with syphilis; a 'soft chancre' is a feature of chancroid."
a[63] = f + "(C) Incorrect. Bowen's disease is carcinoma in situ and is not the result of dermatophytosis."
a[64] = f + "(D) Incorrect. An angiokeratoma is just a small superficial hemangioma--a 'red bump'."
a[65] = f + "(E) CORRECT. The chronic rubbing and scratching from this dermatophyte infection can result in epidermal hyperplasia and chronic inflammation."
a[66] = f + "(A) Incorrect. This virus is associated with squamous epithelial changes, not with prostatitis."
a[67] = f + "(B) Incorrect. HSV is associated with genital vesicles, not with prostatitis."
a[68] = f + "(C) Incorrect. HIV does not produce specific lesions in the genital tract (despite the fact that it is a sexually transmitted disease)."
a[69] = f + "(D) CORRECT. <I>C. trachomatitis</I>, the leading cause of non-gonococcal urethritis, is the most frequent form of prostatitis in young adult men. There is typically no history of chronic urinary tract infection."
a[70] = f + "(E) Incorrect. Such yeast infections are uncommon in this age group and in males."
a[71] = f + "(A) Incorrect. It would be unusual for HSV, which typically affects skin and mucus membranes, to involve the urethra in this fashion."
a[72] = f + "(B) Incorrect. This is the causative agent for syphilis, which can manifest with a hard chancre on skin and mucus membranes."
a[73] = f + "(C) CORRECT. This is the most common non-gonococcal urethritis in males."
a[74] = f + "(D) Incorrect. Mumps virus infection can produce a patchy orchitis."
a[75] = f + "(E) Incorrect. This organism is associated with chancroid (soft chancre)."
a[76] = f + "(A) Incorrect. Hypospadias is a defect of the ventral aspect of the penile urethra."
a[77] = f + "(B) Incorrect. Bowen disease is carcinoma in situ, a neoplastic process not seen in newborns."
a[78] = f + "(C) Incorrect. Balanoposthitis is inflammation of the glans and foreskin, whether anomalous or not."
a[79] = f + "(D) CORRECT. Epispadias is a rare congenital anomaly that may be mild or, as in this case, severe with a large open defect that must be repaired."
a[80] = f + "(E) Incorrect. This results from forcible retraction of a phimotic prepuce, leading to constriction with urethral obstruction."
a[81] = f + "(A) Incorrect. A varicocele, an abnormality of the pampiniform plexus sof veins, is not a complication of vasectomy. In fact, varicocels can be a cause for infertility, and he would not be getting a vasectomy."
a[82] = f + "(B) Incorrect. Orchitis is an infectious process."
a[83] = f + "(C) Incorrect. A hydrocele is a scrotal enlargement from increased fluid around the testis. Though there can be some local pain and edema following vasectomy, this subsides."
a[84] = f + "(D) Incorrect. Torsion is a rare but serious complication of twisting of the testis; this does not follow vasectomy."
a[85] = f + "(E) CORRECT. Also called vasitis nodosa, a sperm granuloma results from a foreign body granulomatous reaction to extravasated sperm at the vasectomy site. The granulomatous reaction is typically not florid."
a[86] = f + "(A) Incorrect. HPV affects squamous epithelium, increasing the risk for dysplasias and carcinoma, but HPV does not affect the testis."
a[87] = f + "(B) Incorrect. Chlamydia is a common cause for urethritis."
a[88] = f + "(C) Incorrect. Gonorrhea may affect the epididymis, but it is less likely to affect the testis in a patchy pattern."
a[89] = f + "(D) CORRECT. This is a very common childhood infection (when vaccinations are not done) resulting in orchitis as well as parotitis. The inflammation rarely causes enough damage to produce a significantly reduced sperm count."
a[90] = f + "(E) Incorrect. HSV affects the skin of the external male genitalia."
a[91] = f + "(A) Incorrect. This is a finding with tertiary syphilis."
a[92] = f + "(B) Incorrect. Gummas are uncommon complications of infection with T. pallidum."
a[93] = f + "(C) Incorrect. This rash is more typical of secondary syphilis."
a[94] = f + "(D) CORRECT. This would be the typical finding for primary syphilis from recent infection by <Treponema pallidum</I>."
a[95] = f + "(E) Incorrect. This is a finding with secondary syphilis."
a[96] = f + "(A) Incorrect. A seminoma can produce a mass lesion with testicular enlargement, but is solid and does not transilluminate."
a[97] = f + "(B) Incorrect. Torsion is uncommon but can occur in younger males and is associated with onset of severe, sudden pain."
a[98] = f + "(C) CORRECT. A hydrocele is just a fluid filled sac that gradually enlarges."
a[99] = f + "(D) Incorrect. A varicocele is an enlarged mass of engorged veins in the pampiniform plexus. It is implicated in about a third of cases of male infertility."
a[100] = f + "(E) Incorrect. This is rare. There is gummatous necrosis with slight enlargement."
a[101] = f + "(A) Incorrect. Premalignant lesions at this site could include 'Bowen's disease' or 'erythroplasia of Queyrat'."
a[102] = f + "(B) Incorrect. HPV can produce condyloma accuminatum."
a[103] = f + "(C) CORRECT. This is really a normal variation, but some patients may be concerned when they find that other males do not have them."
a[104] = f + "(D) Incorrect. Balanitis is a form of inflammation that is more common in uncircumcised males."
a[105] = f + "(E) Incorrect. There is an increased risk for phimosis and for balanitis in uncircumcised males."
a[106] = f + "(A) Incorrect. Prostatic hyperplasia can produce an enlarged prostate, but usually non-tender. The obstruction caused by an enlarged prostate can predispose to recurrent urinary tract infection."
a[107] = f + "(B) Incorrect. The PSA can be slightly elevated with nodular hyperplasia. The PSA is typically elevated to more than twice normal when prostatic adenocarcinoma is present. The presence of a palpable nodule suggests a carcinoma. Prostatic adenocarcinomas are usually non-tender."
a[108] = f + "(C) CORRECT. Chronic bacterial prostatitis should be considered in men who have a history of recurrent bacteriuria. A chronically infected prostate can serve as the source of pathogens for recurrent UTIs. A pattern of relapsing UTIs in a middle-aged man strongly suggests chronic bacterial prostatitis. E. coli is a typical organism associated with urinary tract infection. The PSA can be slightly elevated with prostatic inflammation."
a[109] = f + "(D) Incorrect. A urothelial carcinoma at this location is uncommon. Hematuria is often present. It may cause obstruction and predispose to urinary tract infection."
a[110] = f + "(E) Incorrect. Patients who have signs and symptoms of prostatitis but who have no evidence of prostatic inflammation (normal leukocyte counts) and have negative urine cultures are classified as having prostodynia."
a[111] = f + "(A) Incorrect. Men with seminomas are unlikely to have significant elevations either AFP or HCG. Seminomas are of germ cell origin and are very radiosensitive."
a[112] = f + "(B) CORRECT. Most embryonal carcinomas have a yolk sac cellular component and can secrete alpha-fetoprotein."
a[113] = f + "(C) Incorrect. Leydig cell tumors are benign. They may secrete androgens and/or estrogens."
a[114] = f + "(D) Incorrect. Choriocarcinomas, of germ cell origin, are highly malignant and often secrete HCG."
a[115] = f + "(E) Incorrect. A pure teratoma in a man is very rare. Teratomas are often mixed with embryonal carcinoma, in which case the AFP can be elevated."
a[116] = f + "(A) Incorrect. This is a good method for detection of spirochetes in scrapings from chancres in primary syphilis, but not for chlamydial infection."
a[117] = f + "(B) Incorrect. A cytologic smear is useful for identifying viral cytopathic changes, typically for herpes simplex virus infection, but not for chlamydial infection."
a[118] = f + "(C) Incorrect. Biopsy is typically not employed for diagnosis of STDs."
a[119] = f + "(D) CORRECT. This is the easiest and most cost-effective method, since <I>C. trachomatis</I> cannot be cultured by routine methods."
a[120] = f + "(E) Incorrect. <I>C. trachomatis</I> cannot be cultured by routine methods."
a[121] = f + "(A) CORRECT. This is a congenital anomaly. Infection is a common complication, and partial urethral stricture may lead to urinary tract obstruction."
a[122] = f + "(B) Incorrect. Exstrophy is opening of the bladder through a defect in the lower abdominal wall."
a[123] = f + "(C) Incorrect. This may be an anomaly, but it is more commonly due to inflammation with scarring in uncircumcised males."
a[124] = f + "(D) Incorrect. This congenital anomaly is defined an abnormal opening of urethra on the dorsal aspect of the penis."
a[125] = f + "(E) Incorrect. This condition is failure of normal descent of the testes into the scrotal sac. It occurs in about 1 male in 200."
a[126] = f + "(A) Incorrect. HPV can produce squamous epithelial condylomata, dysplasias, and carcinoma, typically without erythema and edema."
a[127] = f + "(B) CORRECT. He has balanitis with paraphimosis, and staphylococcal or streptococcal infections are most likely to be present."
a[128] = f + "(C) Incorrect. Herpetic infections typically produce vesicular lesions that are episodic in their recurrence."
a[129] = f + "(D) Incorrect. Syphilis may produce the appearance of a hard chancre on the penis."
a[130] = f + "(E) Incorrect. Scabies mites are typically a problem on the hands and less likely to produce itching burrows on the genitalia."
a[131] = f + "(A) Incorrect. Carcinomas are unlikely to arise in this location."
a[132] = f + "(B) Incorrect. Carcinomas are unlikely to arise in this location."
a[133] = f + "(C) CORRECT. Most prostatic adenocarcinomas arise in the peripheral zone where they can potentially be palpated by digital rectal examination."
a[134] = f + "(D) Incorrect. Carcinomas are unlikely to arise in this location, but hyperplasias often involve this zone."
a[135] = f + "(E) Incorrect. Carcinomas are unlikely to arise in this location, but hyperplasias often involve this zone."
a[136] = f + "(A) CORRECT. The findings suggest a chancre of primary syphilis, and a scraping of the lesion put on a glass slide and examined by darkfield microscopy will allow identification of spirochetes within minutes."
a[137] = f + "(B) Incorrect. A cytologic smear is best at identification of epithelial changes associated with herpes simplex virus infection. Herpes is likely to produce smaller and more numerous and painful ulcerations."
a[138] = f + "(C) Incorrect. A tissue biopsy of a chancre will show numerous plasma cells, and a silver stain can highlight the spirochetes, but this is not a cost-effective way for diagnosis of syphilis."
a[139] = f + "(D) Incorrect. Enzyme immunoassay is a good method for diagnosis of <I>Chlamydia trachomatis</I> infections, which are most likely to produce a urethritis."
a[140] = f + "(E) Incorrect. Microbiologic culture is best suited to diagnosis of common bacterial pathogens, including <I>Neisseria gonorrheae</I>, which is unlikely to produce squamous epithelial ulcerations."
a[141] = f + "(A) Incorrect. Choriocarcinomas are highly aggressive and require a combination of treatment methods."
a[142] = f + "(B) Incorrect. Embryonal carcinomas are not highly radiosensitive."
a[143] = f + "(C) CORRECT. Seminomas are the most radiosensitive of testicular carcinomas."
a[144] = f + "(D) Incorrect. Pure teratomas of the testis are uncommon. The mature tissue elements of a teratoma are not highly radiosensitive."
a[145] = f + "(E) Incorrect. Yolk sac tumors (infantile embryonal carcinomas) are rare, but they are the most common form of testicular tumor in children up to the age of 3."
a[146] = f + "(A) Incorrect. Balanoposthitis is inflammation of the glans and foreskin, which is marked by erythema, swelling, and exudate."
a[147] = f + "(B) Incorrect. Epispadias is an abnormal dorsal urethral opening on the penis."
a[148] = f + "(C) Incorrect. Exstrophy is opening of the bladder through a defect in the lower abdominal wall."
a[149] = f + "(D) Incorrect. Hypospadias is an abnormal ventral urethral opening on the penis."
a[150] = f + "(E) CORRECT. Inflammation with scarring may prevent full retraction. There is an increased risk for phimosis and for balanitis in uncircumcised males."
a[151] = f + "(A) CORRECT. Dihydrotestosterone (DHT) is synthesized from circulating testosterone by the action of 5-alpha-reductase type 2. It is DHT which binds to nuclear antigen receptors to stimulate cell growth and proliferation in the prostate."
a[152] = f + "(B) Incorrect. Estrogens are biosynthesized from androgens by the cytochrome P450 enzyme complex called aromatase. Aromatase inhibitors have been employed in control of breast cancers."
a[153] = f + "(C) Incorrect. 17-alpha-hydroxlase is in the pathway from progesterone to hydroxyprogesterone. A deficiency of this enzyme reduces the amount of testosterone produced."
a[154] = f + "(D) Incorrect. Desmolase is the enzyme involved in the initial step of steroid synthesis from cholesterol to pregnenolone."
a[155] = f + "(E) Incorrect. 11-beta-hydroxylase is the enzyme involved with synthesis of both aldosterone and cortisol in the adrenal cortex."
a[156] = f + "(A) Incorrect. A Leydig cell tumor is most often seen in adult men. It may produce androgens and/or estrogens."
a[157] = f + "(B) Incorrect. Neuroblastoma is a childhood tumor most commonly arising in the adrenal."
a[158] = f + "(C) Incorrect. Rhabdomyosarcoma is a childhood tumor that most often arises in the pelvis in the region of the prostate, or in the head & neck region."
a[159] = f + "(D) Incorrect. Teratomas are second to yolk sac tumors in frequency as a testicular neoplasm. That still makes them rare. In adults, teratomas are rarely seen in a pure form, but are mixed with malignant elements, such as embryonal carcinoma."
a[160] = f + "(E) CORRECT. The most common testicular tumor under the age of 3 is a yolk sac tumor (infantile embryonal carcinoma). However, finding any testicular tumor in children is uncommon. The prognosis is good in most cases."
a[161] = f + "(A) Incorrect. This is a small type of hemangioma, which is most common on the surface of the scrotum."
a[162] = f + "(B) Incorrect. Balanitis xerotica obliterans is the male equivalent of lichen sclerosus et atrophicus in the female, which white patches of atrophic epithelium and upper dermal chronic inflammation with fibrosis."
a[163] = f + "(C) CORRECT. This is squamous cell carcinoma in situ. If excised at this stage, it is curable. If not treated, it can progress to an invasive carcinoma."
a[164] = f + "(D) Incorrect. A hard chancre is a focal ulceration that results from primary syphilis infection."
a[165] = f + "(E) Incorrect. Lichen simplex chronicus is epidermal hyperplasia and chronic inflammation that results from chronic rubbing and scratching, possibly secondary to a dermatophyte infection."
a[165.1] = f + "(F) Incorrect. Paraphimosis occurs when phimotic foreskin becomes irreversibly retracted over the glans penis, resulting in edema of glans secondary to compromised venous/lymphatic return."
a[166] = f + "(A) Incorrect. Choriocarcinoma is a highly malignant form of germ cell neoplasm, typically producing significant amounts of HCG from the syncytial cells."
a[167] = f + "(B) Incorrect. Embryonal carcinomas typically are associated with elevations in the alpha-fetoprotein. They tend to be large masses."
a[168] = f + "(C) CORRECT. A Leydig cell tumor is most often seen in adult men. It may produce androgens and/or estrogens, leading to gynecomastia and/or feminization. It is histologically benign. Most are small in size."
a[169] = f + "(D) Incorrect. Seminoma is the most common form of pure germ cell tumor of the testis. They may be associated with modest elevations of HCG. They do not produce estrogens or androgens."
a[170] = f + "(E) Incorrect. The most common testicular tumor under the age of 3 is a yolk sac tumor (infantile embryonal carcinoma). There is typically an elevaed serum alpha-fetoprotein."