The patient was a 91-year-old woman. Laboratory data were as follows: AST 35 IU/l (normal 5-35), ALT 21 IU/l (normal 5-30), ALP 198 U/l (normal 115-359), gamma-GTP 67 IU/l (normal 0-50), LDH 162 IU/l (normal 106-211), Alb 2.9 g/dl (normal 3.7-5.5), TB 0.7 mg/dl (normal 0.2-1.0), and PT-INR 1.18. Child-Turcotte-Pugh grade was A. The ICG-R15 was 19%. The concentration of serum AFP was 1,210 ng/ml (normal <20) and plasma DCP was 209 mAU/ml (normal <40). No serological evidence of hepatitis B or C was seen. CECT revealed a tumor measuring 20 mm in diameter in segment 2 of the liver, accompanied by tumor thrombi toward the main left portal vein (fig. 4). We diagnosed HCC with tumor thrombi. The patient requested radical surgery, so left hemi-hepatectomy was performed (fig. 5). The operation time was 304 min, and the amount of blood loss was 379 ml. Pathological findings revealed poorly differentiated HCC (fig. 6).