Aim-Solid and papillary epithelial neoplasm (SPEN) is an uncommon pancreatic tumour. Very rarely it has also been described outside the pancreas, usually arising from heterotopic pancreatic tissue. This report summarises all the published extrapancreatic SPENs and documents the sixth such case arising from heterotopic pancreatic tissue of the transverse mesocolon in a 15 year old girl. Methods/Results-Histological and immunohistochemical examination revealed typical papillary and solid areas composed of columnar, cuboidal, and round cells, which were focally positive for vimentin, cytokeratin, neurone specific enolase, carcinoembryonic antigen, 1-antitrypsin, 1-antichymotrypsin, and negative for neuroendocrine markers (neurofilament, PGP 9.5, chromogranin A, synaptophysin, and S100), p53, and oestrogen and progesterone receptors. Electron microscopy showed scant zymogen but no neurosecretory granules. In agreement with the flow cytometric result of diploidy, comparative genomic hybridisation (CGH) did not reveal loss or gain of genetic material, and the in situ hybridisation analysis of the RB1 and p53 genes revealed no abnormality in the 13q and 17p arms. Conclusions-Immunohistochemical and electron microscopic data support exocrine diVerentiation. The CGH and the flow cytometric results suggest a subtle, yet unknown genetic change, rather than a large genetic alteration. RB1 and p53 in situ hybridisation ruled out the role of deletion at these sites in the pathogenesis of SPEN. Interestingly, review of the published and the present heterotopic pancreatic SPENs identified the mesocolon as the most common anatomical site (four of six), despite the very rare occurrence of ectopic pancreatic tissue at this site. (J Clin Pathol 2001;54:241-246) Keywords: solid papillary epithelial neoplasm; heterotopic/ectopic pancreas; mesocolon Solid and papillary epithelial neoplasm (SPEN) is a rare tumour in the pancreas. Although more than 300 cases have been reported in the pancreas, the occurrence of SPEN at a heterotopic site is not well recognised. Our literature review identified only five previously published cases.1-5 The histological diagnosis of SPEN is often diYcult, even more so when it occurs at an ectopic site. The histogenesis is still poorly understood and the molecular pathological data are limited. A 15 year old girl was admitted to the department of paediatrics, University Medical School of Pécs, Hungary, with a history of abdominal pain of recent onset and abdominal distention of several years duration. On physical examination, a large tumour filling the left hypochondrium was identified. On the computed tomography (CT) scan a hypodense, intraperitoneal, circumscribed mass dislocating the spleen and left kidney was observed ( fig 1). On laparotomy, a spherical, encapsulated tumour mass was located in the mesocolon. The tumour was not attached to the pancreas and did not appear to invade the colonic wall. It was resected with a segment of transverse colon.The surgical specimen consisted of a circu...