The tumor was diagnosed as HCC because: (1) the imaging findings were compatible with HCC, (2) alpha-fetoprotein and PIVKA-II were elevated, (3) it was very unlikely that the past mucosal bile duct adenocarcinoma had metastasized to the liver, and (4) gastrointestinal endoscopy and colonoscopy did not find any primary diseases. Here, AFP is linked to hepatocellular carcinoma.