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The MRI demonstrated multiple intracerebral metastases, while a supplementary fluoro-deoxy-glucose positron emission tomography scan revealed metastatic lesions above and below the diaphragm, without signs of a primary tumour. An ear, nose and throat examination found a small supraglottic tumour and cervical lymph node metastases. Following a multidisciplinary team discussion, biopsies from the duodenal mucosa and an inguinal lymph node were performed, showing squamous cell carcinoma with its origin in the head and neck. 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