On rare occasions, patients with germ cell tumors may present with respiratory compromise secondary to massive pulmonary metastases. In this circumstance, systemic chemotherapy is initiated on an emergent basis in lieu of radical orchiectomy. Although most patients would likely tolerate a primary orchiectomy, respiratory failure represents the most immediate threat to life and warrants directed therapy as such. Radical orchiectomy is generally performed within a few weeks of initiating chemotherapy.
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