Aboud Journal of Medical Case Reports 2011, 5:220 http://www.jmedicalcasereports.com/content/5/1/220 left neck without extension into the mediastinum. The mass caused mild deformity and deviation of the left mandible and masticator muscles anteriorly. The airway at the pharyngomucosal space was compressed and ste- nosed. A CT scan of our patient’s brain and neck showed a large heterogeneous mass extending from the base of the skull to the left submandibular region; a cys- tic component was also noted. Findings from a CT scan of the brain were normal. The initial diagnosis was cys- tic hygroma. Our patient then received total excision of the cystic mass and prevention of airway obstruction by a left submandibular approach (Figure 1). During sur- gery, a large cystic mass filled with clean fluid over the left parapharyngeal space was noted. The mass adhered strongly to the surrounding tissues. The gross pathology showed a grayish mass, measuring 6 cm across its lar- gest dimension, with a whitish soft cut section (Figure 2). Results of the histological examination showed it to be a neuroglial heterotopia, composed predominantly of glial cells in a neurofibrillary matrix containing a cleft lined by apendymal-like columnar cells and surrounded by meninges, with no malignancy (Figure 3). The final diagnosis was heterotopic brain tissue. There were no post-operative complications and our patient was dis- charged in good health on the fifth day. No recurrence or complications have been noted in two months of fol- low-up. Discussion Heterotopic neuroglial tissue (HNT) was first described by Reid in 1852 [13]. Composed of differentiated neu- roectodermal tissue, these lesions represent developmen- tal heterotopia of neuroglial tissue rather than true neoplasms [3,10]. Unlike meningoencephaloceles, brain heterotopias lack connection with the subarachnoid Page 2 of 3 Figure 2 Gross pathology, showing a grayish mass measuring 6 cm across its largest dimension, with a whitish, soft cut section. space [14,15]. Patients are usually seen initially in the newborn period with airway obstruction, feeding diffi- culty, or a neck mass. The most common location of HNT is the nasal cavity, where it is traditionally but erroneously termed ‘nasal glioma’. Less commonly, brain heterotopias have been reported in the scalp, tongue, pharynx, palate, orbit, and neck [3]. The majority of patients with HNT are products of uncomplicated preg- nancies. This anomaly seems to have a left side and female predominance in previously reported cases [3-5], as in our case. Other associated developmental anoma- lies have been reported, such as cleft palate, Pierre- Robin syndrome, and congenital heart disease [3-5]. The pathogenesis of heterotopic neuroglial tissue is unclear. Several mechanisms have been proposed. CT and MRI scans are complementary studies necessary in pre- Figure 1 Peri-operative complete mass excision. Figure 3 Histological examination showing neuroglial heterotopia, composed predominantly of glial cells in a neurofibrillary matrix.