Hepatocellular carcinoma presenting with bleeding due to duodenal perforation by the tumor

A 70-year-old man was admitted with upper GI bleeding. Endoscopy showed a large duodenal bleeding mass. The aspect of the tumor was macroscopically similar to the liver surface. The diagnosis of hepatocellular carcinoma was made by aspiration cytology guided by abdominal computed tomographic scan. The postmortem examination revealed an extensive primary hepatic tumor which caused an ulcer in the first part of the duodenum and protruded into the lumen. This unusual presentation of a hepatocellular carcinoma has not been previously reported.