Mucoepidermoid carcinoma is most commonly found in the parotid gland. It rarely occurs in the larynx and hypopharynx. There are only 32 reported cases from these areas. A case of a mucoepidermoid carcinoma of the hypopharynx is presented. Although the initial impression was squamous cell carcinoma, glandular structures were found in metastatic lymph nodes in the neck specimen, and after mucicarmine stains were positive, the final diagnosis was changed to mucoepidermoid carcinoma. This case illustrates the difficulty in diagnosing mucoepidermoid carcinoma, especially in unexpected locations. Differentiating mucoepidermoid carcinoma from other neoplasms is important because treatment may differ depending on the diagnosis. The pathologic spectrum of mucoepidermoid carcinoma is presented, and the management of these tumors with respect to the histologic grade is discussed.