A 22-year-old Asian male developed testicular alpha-fetoprotein (AFP)-secreting germ cell tumor 3 years after treatment of a disseminated intracranial lesion identified as non-secreting germ cell tumor on the basis of clinical data. Magnetic resonance imaging showed a massive lesion with necrosis appearing as hypointense on T₁- and hyperintense on T₂-weighted imaging, with heterogeneous enhancement. The blood AFP level was as high as 129 ng/ml (previously, as low as 5 ng/ml) and abdominal computed tomography showed para-aortic lymph node swelling. Left orchidectomy was performed and histological examination indicated the presence of AFP-secreting germ cell tumor despite severe necrosis of the tissue. Improved chemoradiotherapy for intracranial germ cell tumor will lead to long-term survival of most patients with germ cell tumor. Patients may subsequently develop germ cell tumors at other sites in the body. Therefore, follow up should monitor for tumor recurrence not only in the brain but also in other locations.