How do you treat metastatic testicular cancer with the primary orchiectomy pathology showing non-seminoma with components of teratoma and primitive neuroectodermal tumor?  

If such a patient had evidence of widespread metastases with normal tumor markers, I would have the pathology on the orch specimen reviewed at an experienced center. Assuming that review confirms PNET component, I would consider systemic chemotherapy with alternating VIP/CAV. It is very unlikely to ...