1. 45 yrs old male pt with no co morbids non addictive non smoker Huge scrotal swelling > on left side -- 02 yrs. Productive cough – 03 months O/Exam: huge scrotal swelling with left testicular mass, no cough impulse & its irreducible, mild cystic on rt. side

2. Scrotal U/S: (8/x/15) scattered calcifications & hypoechoic shadows seen in Lt. hemiscrotum. 11 x 6.4 x6.9 cm in size, mild hydrocele on Rt. side of scrotum.

3. CXR: multiple masses involving both lungs. Ct scan chest: multiple varying sizes nodules seen in both lungs, suspicious of metastatic pulm: nodules, mass is abutting the major mediastinal vessels and left medial border of heart. Bx taken from left lung nodule (ojha kchi) H/Path: (dow & aku) desmin, myogenin, myo D1 CD34, WT1 all are +ve IHC features favor RMS

4. Ct scan abdomen/pelvis: left testicular mass 5x5cm with surrounding fluid, spleenomegaly mesenteric, para aortic & left inguinal lymph adenopathy seen. Bone scan (aku) --- N Bone Marrow------N

5. Echocardiography: dilated left atrium, thrombus/clots seen more in left ventricle @ mitral valve. LVEF 65% 25/10/15 AFP---- 1048

6. Management? Chemotherapy? Regimen? Left Inguinal Orchiectomy Best supprtive care