A cystic mass in level II on the left side of the patient had been extirpated about three weeks ago. Contrary to expectations, the histology revealed a cystic metastasis of an HPV-positive carcinoma. Therefore, CUP syndrome in the absence of clinical evidence of primarius. PET-CT also showed no evidence of a primary tumor. No other conspicuous nodules on the neck. Therefore, indication for CUP panendoscopy, PEG placement and left neck dissection revision.