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Low-grade adenosquamous carcinoma is an extremely rare and histologically distinct tumor, possessing both squamous and glandular components. A variant of metaplastic carcinoma, it is locally aggressive but regional lymph node metastases are exceptional, and as such patients rarely require systemic therapy. We herein present a case of bilateral low-grade adenosquamous carcinoma, with clinical, pathology and imaging correlation highlighting the salient features of this disease.