An Unusual Case of Biliary Obstruction Because of Human Papillomavirus–Associated Metastatic Squamous Cell Carcinoma From Head and Neck Primary

Abstract

Secondary pancreatic tumors are uncommon, with the majority originating from primary gastrointestinal or lung cancers. We present the case of a 42-year-old woman with squamous cell carcinoma of the pancreas, found to be human papillomavirus-positive on in situ hybridization. After extensive work-up, the patient was determined to have a previously undiagnosed, asymptomatic head and neck primary malignancy. There is sparse literature discussing metastatic human papillomavirus-positive squamous cell carcinoma to the pancreas. This report highlights the importance of including this diagnosis when considering a differential for secondary pancreatic tumors, especially squamous etiology. CASE REPORTA 42-year-old woman with a history of anemia presented with 5 months of epigastric pain radiating to the back. The patient reported decreased appetite with nausea and vomiting and a 30-pound unintentional weight loss. Her epigastric pain worsened in intensity over several weeks and was associated with darkened urine. She endorsed several weeks of constipation but denied pale-colored stools or steatorrhea. The patient had a family history significant for colorectal cancer in multiple family members. She denied a history of