The ubiquitous occurrence of microplastics (MPs) in the marine environment is raising concern for interactions with marine organisms. These particles efficiently adsorb persistent organic pollutants from surrounding environment and, due to the small size, they are easily available for ingestion at all trophic levels. Once ingested, MPs can induce mechanical damage, sub-lethal effects, and various cellular responses, further modulated by possible release of adsorbed chemicals or additives. In this study, ecotoxicological effects of MPs and their interactions with benzo(a)pyrene (BaP), chosen as a model compound for polycyclic aromatic hydrocarbons (PAHs) were investigated in Mediterranean mussels, Mytilus galloprovincialis. Organisms were exposed for 4 weeks to 10 mg/L of low-density polyethylene (LDPE) microparticles (2.34 * 10⁷ particles/L, size range 20–25 μm), both virgin and pre-contaminated with BaP (15 μg/g). Organisms were also exposed for comparison to BaP dosed alone at 150 ng/L, corresponding to the amount adsorbed on microplastics. Tissue localization of microplastics was histologically evaluated; chemical analyses and a wide battery of biomarkers covering molecular, biochemical and cellular levels allowed to evaluate BaP bioaccumulation, alterations of immune system, antioxidant defenses, onset of oxidative stress, peroxisomal proliferation, genotoxicity, and neurotoxicity. Obtained data were elaborated within a quantitative weight of evidence (WOE) model which, using weighted criteria, provided synthetic hazard indices, for both chemical and cellular results, before their integration in a combined index. Microplastics were localized in hemolymph, gills, and especially digestive tissues where a potential transfer of BaP from MPs was also observed. Significant alterations were measured on the immune system, while more limited effects occurred on the oxidative status, neurotoxicity, and genotoxicity, with a different susceptibility of analyzed pathways, depending on tissue, time, and typology of exposure. Molecular analyses confirmed the general lack of significant transcriptional variations of antioxidant and stress genes. The overall results suggest that microplastics induce a slight cellular toxicity under short-term (28 days) exposure conditions. However, modulation of immune responses, along with bioaccumulation of BaP, pose the still unexplored risk that these particles, under conditions of more chronic exposure (months to years) or interacting with other stressors, may provoke long-term, subtle effects on organisms' health status.