HPV-positive, T2N2cM1 squamous cell carcinoma of the left tonsil progressed on pembro, Extreme(carbo/5fu/cetux), BKM 120/cetuximab. An occipital brain lesion was treated with SBRT. There is a newly apparent peripherally enhancing lesion in the right perirolandic region that measures up to 7 mm in width. Otherwise, a right occipital lobe enhancing lesion has markedly decreased in size, now measuring 2 mm in width, previously 7 mm. There is no evidence of intracranial hemorrhage or acute infarct. There is scattered cerebral white matter T2hyperintensity, predominantly in a periventricular distribution. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1, A new subcentimeter right perirolandic lesion likely represents a metastasis.2. A right occipital metastatic lesion has markedly decreased in size in response to treatment. 