A poorly differentiated left cervical squamous cell carcinoma metastasis was histologically confirmed in the patient. The panendoscopy initially performed showed a clear support for a primary tumor. In addition to the extensive cervical lymph node metastasis, the PET-CT showed a primary, suspicious lesion in the left hypopharyngeal region, as well as an inflammatory process in the lung, but no evidence of distant metastases. Preoperatively, our pulmonology department was able to rule out active TB. In our interdisciplinary tumor conference and in a detailed discussion with the patient and relatives, the primary surgical treatment was decided. Depending on the local extent of the tumor, this may even include a laryngectomy as a last resort.