Doppelganger in the salivary gland, a rare mucoepidermoid carcinoma display

Worldwide cancer burden and newer variants of existing cancers are unceasingly increasing. Awareness of varied and unusual presentations of mucoepidermoid carcinoma (MEC) is crucial to prevent delay in management. This report aims to disseminate clinical information regarding Warthin-like MEC and the diagnostic pitfalls encountered. A 65-year-old male presented to ENT OPD with the left parotid swelling. Imaging studies (contrast-enhanced computed tomography and magnetic resonance imaging scan), ultrasound-guided fine needle aspiration cytology and Frozen sections all demonstrates findings suggesting Warthin's tumor. However, histopathological features revealed lymphoid aggregate with germinal center, three cells: mucinous, epidermoid, and intermediate and with foci of invasion. These points to Warthin-like MEC, low grade (AFIP scheme). Warthin-like MEC of the parotid gland is rare as well as newer variant and is often misdiagnosed as Metaplastic Warthin's tumor. Clinicians/oncologists and pathologists need to be vigilant in terms of high index of suspicion and early detection of such rare variants and presentations of MEC, to provide prompt management.