Mixed Mucoepidermoid Carcinoma of the Pancreatic Head: A Case Report and Review of the Literature

Introduction. Mucoepidermoid carcinoma (MEC) of the pancreas is an exceptionally rare malignancy with fewer than twenty cases reported in the English-language literature. Its pathogenesis, optimal management, and prognosis remain poorly characterised. Material and methods. We report a case of mixed mucoepidermoid carcinoma of the pancreatic head diagnosed at our institution and provide a narrative review of all comparable cases identified in the literature through 2024. Results. A 69-year-old man presented with progressive cholestatic jaundice and weight loss. CT imaging revealed a 28 mm mass in the pancreatic head with portal vein invasion. CA19-9 was 500 U/mL. Biliary decompression was achieved by ERCP with stenting. Histopathological biopsy confirmed mixed mucoepidermoid pancreatic carcinoma. Given locally advanced unresectable disease, gemcitabine monotherapy (1000 mg/m², D1-D8-D15, q28d) was initiated. After three cycles, imaging showed tumour progression (40×34 mm), portal thrombosis, ascites, and CA19-9 rising to 28,940 U/mL. A switch to FOLFOX was planned but could not be administered due to rapid clinical deterioration. The patient died approximately five months after diagnosis. Conclusions. Mixed mucoepidermoid carcinoma of the pancreas is an aggressive and therapeutically challenging entity. Surgical resection remains the only treatment associated with prolonged survival. Gemcitabine monotherapy appears inadequate for locally advanced disease. Immunohistochemical and molecular characterisation is essential. This case is, to our knowledge, the first reported from Africa.