title: Solitary dural metastasis at presentation in a patient with untreated human papillomavirus-associated squamous cell carcinoma of the oropharynx.
abstract: BACKGROUND
  Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (SCC) is associated with high cure rates and distant metastases are rare.
  
  
  RESULTS
  We report a case of a 61-year-old man presenting with acute left-sided weakness. An enhancing dural mass was noted and resected. Histology revealed p16-positive SCC. Further workup revealed a p16-positive right tonsillar primary with ipsilateral nodal disease and was classified as T2N2bM1. The patient underwent whole brain irradiation and definitive chemoradiation with curative intent. Complete clinical response was achieved and the patient continues to be disease-free 6 months posttreatment.
  
  
  CONCLUSIONS
  HPV-associated oligometastatic oropharyngeal SCC is a rare entity that may have a unique natural history and behavior. Given the excellent treatment response and prognosis of HPV-positive disease in general, these patients may be appropriate for definitive treatment approaches.
authors.affiliation: Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Samer
authors.initials: S
authors.lastname: Al-Khudari
authors.forename: Susan
authors.initials: S
authors.lastname: Guo
authors.forename: Yunwei
authors.initials: Y
authors.lastname: Chen
authors.forename: Tobenna
authors.initials: T
authors.lastname: Nwizu
authors.forename: John F
authors.initials: JF
authors.lastname: Greskovich
authors.forename: Robert
authors.initials: R
authors.lastname: Lorenz
authors.forename: Brian B
authors.initials: BB
authors.lastname: Burkey
authors.forename: David J
authors.initials: DJ
authors.lastname: Adelstein
authors.forename: Shlomo A
authors.initials: SA
authors.lastname: Koyfman
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary* / Q000821:virology; D019941:Cyclin-Dependent Kinase Inhibitor p16; D004388:Dura Mater; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000821:virology*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008577:Meningeal Neoplasms / Q000556:secondary* / Q000821:virology*; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000378:metabolism; D011879:Radiotherapy Dosage; D000077195:Squamous Cell Carcinoma of Head and Neck; D014067:Tonsillar Neoplasms / Q000473:pathology* / Q000821:virology*
chemical_list: C000614131:CDKN2A protein, human; D019941:Cyclin-Dependent Kinase Inhibitor p16; D009363:Neoplasm Proteins
keywords: dural metastasis; human papillomavirus; tonsillar cancer