Core biopsy of the right nodal mass demonstrate P16 positive squamous cell carcinoma.

This is an extensive primary tumor, with local destruction of mucosal structures and extension beyond the central neck.

The large (predominantly cystic) nodal mass measures over 6 cm, with venous invasion - even in the absence of contralateral disease this results in the highest clinical nodal stage of cN3.

The suspected pulmonary metastases then push the classification higher still into group IV.

The patient was subsequently managed with best supportive care.