Pediatric intussusception is usually idiopathic in origin, and a pathological lesion at the leadpoint is identified in only a small proportion of cases. Meckel's diverticulum is the most common location when such a lesion is found. Heterotopic pancreas has been seen most frequently in the stomach or duodenum; however, ileal lesions are rare. In the ileum, heterotopic pancreas is usually associated with Meckel's diverticulum and may cause intestinal obstruction by intussusception. However, isolated heterotopic pancreas in the ileum is distinctly rare and usually discovered incidentally during surgery for other conditions. In a review of English language literature, there were only a few pediatric cases of isolated ileal heterotopic pancreas causing intussusception. We report three additional pediatric cases and discuss the clinical significance of this unexpected rare entity.

A 7-year-old boy who presented with a painful left hemiscrotal mass was diagnosed with acquired lymphangioma of the scrotum. Chronic friction from a cast for Perthes' disease might have been the cause of sudden enlargement of a congenital lymphangioma of the scrotum. Magnetic resonance imaging (MRI) was useful for preoperative diagnosis and determining the extent of the scrotal lesions. Total excision of the mass leaving the overlying skin was successfully performed. The clinical significance of MRI for preoperative diagnosis and planning surgical resection of this lesion is discussed.

Duodenogastric reflux (DGR) was assessed in patients surgically treated for choledochal cyst, with emphasis on two different biliary reconstruction methods: Roux-en-Y hepaticojejunostomy (HJ) and hepaticoduodenostomy (HD). Gastric bile monitoring with the Bilitec device revealed excessive DGR in patients in the HD group. Endoscopic findings demonstrated mild to moderate gastric mucosal erosion in patients after HD. In contrast, neither DGR nor gastritis was found in patients after HJ. This preliminary study suggests that HJ, rather than HD, should be recommended as a method of biliary reconstruction for pediatric patients with choledochal cyst. Careful observation of DGR should be continued in patients who have undergone HD.

An exceedingly rare case of prenatally diagnosed cystic neuroblastoma (NB) is described. Prenatal ultrasonography at 28 weeks' gestation revealed a cystic right suprarenal mass that measured 15 x 17 mm in diameter. The mass increased parallel to fetal size until it was 41 x 44 mm in diameter at 39 weeks' gestation. Magnetic resonance imaging performed prenatally and after delivery showed two different intracystic intensities with fluid levels, suggesting intracystic hemorrhage. The patient underwent a right adrenalectomy at 20 days of age, and the resected tumor was diagnosed as a poorly-differentiated ganglioneuroblastoma. Eight months after surgery, the patient is generally healthy with no evidence of recurrence. We reviewed 25 additional cases of prenatally diagnosed adrenal cystic NB and examined the clinical features of this rare entity.

Local administration of paclitaxel may be useful for treatment of breast cancer.