Abstract Introduction/Objective Alpha-fetoprotein (AFP)-producing gastric carcinoma (AFPGC) is a rare and aggressive subtype of gastric cancer characterized by the production of AFP. It is well known for its morphological heterogeneity, displaying a wide spectrum of histological patterns that can mimic other tumor types including hepatocellular carcinoma (HCC), which is similarly associated with AFP elevation, complicating its identification. We report a case of an AFPGC encountered in a liver biopsy. Methods/Case Report A 60-year-old male presented with chronic abdominal pain and unintentional weight loss over the past few months with associated mild constipation and nausea. The patient denied melena or hematochezia. An abdominal CT scan revealed multiple round lesions within the liver, the largest measuring 4.9 cm, without evident primary site. AFP and CEA were elevated at 2883.0 ng/ml and 36.7 ng/ml, respectively. A liver biopsy demonstrated a proliferation of polygonal cells with eosinophilic to clear cytoplasm in a predominantly trabecular and focally acinar/pseudoglandular growth pattern. The tumor cells were positive for Glypican-3, SALL4, CDX-2 and AE1/AE3 while negative for HepPar-1 and Arginase-1. While the tumor's immunoprofile and histomorphology along with elevated serum AFP suggested poorly differentiated HCC, the multifocality of lesions raised a possibility of a metastatic AFPGC. Subsequent upper endoscopic ultrasound prompted by pathology report revealed a large gastric mass and the biopsy showed conventional adenocarcinoma with similar immunoprofile. Colonoscopy showed a cecal polyp consisting of a diffuse proliferation of signet ring cells without a precursor, consistent with metastatic AFPGC. Results (if a Case Study enter NA) NA Conclusion AFPGC is known for its morphologic heterogeneity and mimicry of other entities. This case highlights the importance of considering metastatic AFPGC when tumors with unusual presentation show SALL4 positivity in the setting of elevated AFP. Hepatoid morphology of AFPGC in the liver can be a diagnostic pitfall especially when the primary site is unknown.