A 60-year-old man was transported to our hospital with hematemesis. Upon admission, emergency esophagogastroduodenoscopy revealed an elevated, submucosal lesion just below the gastroesophageal junction. The top of the lesion was ulcerated and this seemed to be the source of the bleeding. Laboratory data showed liver dysfunction and enhanced computed tomography revealed a massive tumor ranging from the cardia to the left hepatic lobe. Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) of the tumor through the gastric wall revealed pathological hepatocellular carcinoma (HCC) and direct extrahepatic HCC invasion of the gastric wall was diagnosed. Extrahepatic HCC is rare among the types of primary liver cancer. EUS-FNA helped to achieve an accurate diagnosis. We believe that EUS-FNA is useful, not only for pancreatic cancer and submucosal tumors of the digestive tract, but also for extrahepatic hepatocellular carcinoma.
