Adenosquamous carcinoma with mucoepidermoid carcinoma-like features: A debatable masquerader!

Pancreatic adenosquamous carcinoma with mucoepidermoid carcinoma (MEC)-like features is an exceedingly rare entity with 30 cases reported till date. Preoperative diagnosis is invariably challenging on cytology. We present a case of a gentleman in his mid-thirties, who presented with abdominal pain and jaundice. No rearrangement of MAML2 gene was detected on fluorescence in situ hybridization. A diagnosis of adenosquamous carcinoma with MEC-like features was rendered. On the basis of deceptive morphology, these tumors should not be misdiagnosed as MEC because unlike their salivary gland counterparts, these tumors have a dismal prognosis. Our paper aims to increase the awareness and help in understanding the biological behavior of this rare morphological subtype in the pancreas. Accurate diagnosis has important prognostic implications and forms a rationale to aid patient selection for vigorous adjuvant therapeutics in view of its aggressive course and dismal prognosis.