Testicular germ cell tumors are generally rare but represent the most common solid neoplasms in young men. They are subdivided into seminomas and non-seminomatous germ cell tumors. Usually the diagnosis of a seminoma is straightforward due to the characteristic morphology, although problems in differential diagnosis can occur because of unusual histological growth patterns. This article describes the challenging differential diagnosis with respect to seminomas versus non-seminomatous germ cell tumors, sex cord stromal tumors, lymphomas and non-neoplastic conditions, such as scars and inflammatory changes. In addition, prognostic factors for seminomas are presented and discussed.