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Rare large ab initio calcifications of a primary mediastinal seminoma in a 16-year-old boy and of para-aortic nodal metastatic ovarian seminoma in a 14-year-old girl are demonstrated with CT but not with conventional radiography. They are most likely dystrophic calcifications because of the absence of other germ cell tumor components and infective granulomatous disease. Routine use of CT might detect more such calcifications in untreated seminoma.

Radiation therapy has been the usual initial treatment for mediastinal seminoma in the past. However, 25 to 40 percent of patients are not cured by this therapy, and other therapy is needed. Review of case reports show that vinblastine, bleomycin, and cis-platinum are effective therapy for metastatic disease, advanced disease within the chest, or mixed germ cell tumors with nonseminomatous elements. The use of tumor markers and chemotherapy must be integrated into the staging of and therapy for primary mediastinal seminoma.

Two cases of primary mediastinal seminoma are presented. The short history and the importance of extensive preoperative studies are emphasized. Final diagnosis was established by generous surgical biopsy. Although left diaphragmatic paralysis was present in case 1, the tumor responded temporarily to x-ray therapy in both cases. Complete surgical resection was not feasible in either case; therefore, radiation was the treatment of choice. Seminoma in this location carries a better prognosis than other germ cell tumors of the mediastinum.