Aboud Journal of Medical Case Reports 2011, 5:220 http://www.jmedicalcasereports.com/content/5/1/220 operative planning to determine the extent and location of the mass and to exclude intra-cranial connection [16]. Surgical excision is the treatment of choice, although the time it should be performed is controver- sial. Before surgery, it is difficult to differentiate the neu- roglial heterotopia from lymphangioma, as in cases such as our patient. The only clue is a giant single locular (as in our case) rather than multiseptated cyst, which can be commonly seen in lymphangioma; however, heteroto- pic neuroglial tissue presenting as a giant single locular cyst has been reported on a few occasions. Another way to differentiate these two entities is laboratory study of the fluid. The treatment for heterotopic brain tissue is complete surgical excision. Surgical intervention is necessary in patients with heterotopic parapharyngeal neuroglial tis- sue that causes airway distress, dysphagia, or failure to thrive. The timing of surgery is controversial. Propo- nents of delayed resection believe that resection might be safer in the older child, in whom vital neurovascular structures are more easily salvageable and blood volume is greater [3-6]. Recurrence as a result of incomplete excision has been described [5]. Although focal areas of immature cells have been reported [17,18], these masses lack invasive patterns and are not true neoplasms. Rig- orous post-operative care includes attention to nutri- tional status and speech and swallowing therapy [6]. Conclusions In summary, pure cystic neck brain tissue heterotopias are very uncommon lesions, and a pre-operative diagno- sis of this lesion is difficult. Heterotopic brain is a rare, benign condition that should be considered in the differ- ential diagnosis of the neonatal head and neck masses. Consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Acknowledgements The author expresses sincere gratitude to all the Pediatric Surgery Unit staff at the Maternity And Child Teaching Hospital, Al-Qadisiya, Iraq, for their assistance. Thanks also go to Dr Luaay E Alkhury (pathologist), who performed the histopathological examination of the mass. The author read and approved the final manuscript. Competing interests The author declares that they have no competing interests. Received: 4 November 2009 Accepted: 8 June 2011 Published: 8 June 2011 References 1. Azumi N, Matsuno T, Tateyama M, Inoue K: So-called nasal glioma. Acta Pathol Jpn 1984, 34:215-220. Page 3 of 3 2. Hendrikson M, Faye-Petersen O, Johnson DG: Cystic and solid heterotopic brain in the face and neck: a review and report of an unusual case. J Pediatr Surg 1990, 25:766-768. 3. Broniatowski M, Witt WJ, Shah AC, Galloway PG, Abramowsky CR: Glial tissue in the parapharyngeal space. Arch Otolaryngol 1981, 107:638-641. 4. Forte V, Friedberg J, Thorner P, Park A: Heterotopic brain in the parapharyngeal space. Int J Pediatr Otorhinolaryngol 1996, 37:253-260. 5. Behar PM, Muller S, Gerber ME, Todd NM: Heterotopic neurotopic neuroglial tissue causing airway obstruction in the newborn. Arch Otolaryngol Head Neck Surg 2001, 127:997-1002. 6. Chen CY, Huang JH: Parapharyngeal neuroglial heterotopia presenting as a growing single locular cyst: MR imaging findings. Am J Neuroradiol 2005, 26:96-99. 7. Ducic Y: Nasal gliomas. J Otolaryngol 1999, 28:285-287. 8. Uemura T, Yoshikawa A, Onizuka T, Hayashi T: Heterotopic nasopharyngeal brain tissue associated with cleft palate. Cleft Palate Craniofac J 1999, 36:248-251. 9. Hendrickson M, Faye-Petersen O, Johnson DG: Cystic and solid heterotopic brain in the face and neck: a review and report of an unusual case. J Pediatr Surg 1990, 25:766-768. 10. Robbins SH, Tomaszewski MM, Garcia VF, Eggli KD, d’Avis JC: Heterotopic brain presenting as a cystic neck mass with mandibular deformity. Pediatr Pathol 1985, 4:341-349. 11. Chen CY, Huang JH, Choi WM, Chen CL, Chan WP: Parapharyngeal neurological heterotopia presenting as a growing single locular cyst. AJNR Am J Neuroradiol 2005, 26:96-99. 12. Chan CY, Lim KE: Cystic heterotopic brain tissue presenting as a unilateral neck mass. Tzu Chi Med J 2006, 18:217-219. 13. Kallman JE, Loevner LA, Yousem DM, Chalian AA, Lanza DC, Jin L, Hayden RE: Heterotopic brain in the pterygopalatine fossa. AJNR Am J Neuroradiol 1997, 18:176-179. 14. Madjidi A, Couley G: Heterotopic neuroglial tissue of the face. Oral Surg Oral Med Oral Pathol 1993, 76:284-288. 15. Seibert RW, Seibert JJ, Jimenez JF, Angtuaco EJ: Nasopharyngeal brain heterotopia: a cause of upper airway obstruction in infancy. Laryngoscope 1984, 94:818-819. 16. Patterson K, Kapur S, Chandra R: Nasal glioma and related brain heterotopias: a pathologist’s perspective. Pediatr Pathol 1986, 5:353-361. 17. Bossen EH, Hudson WR: Oligodendroglioma arising in heterotopic brain tissue of the soft palate and nasopharynx. Am J Surg Pathol 1987, 11:571-574. 18. Lee SC, Henry MM, Gonzalez-Crussi F: Simultaneous occurrence of melanotic neuroectodermal tumor and brain heterotopia in the oropharynx. Cancer 1967, 38:249-253. doi:10.1186/1752-1947-5-220 Cite this article as: Aboud: Respiratory difficulty caused by an ectopic brain tissue mass in the neck of a two-month-old baby: a case report. Journal of Medical Case Reports 2011 5:220. Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color ﬁgure charges • Immediate publication on acceptance • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit