An 80-year-old woman with diabetes and nonalcoholic steatohepatitis -related cirrhosis was admitted for anorexia and epigastralgia. Although AFP, CA125, interleukin-2 receptor, and ferritin were elevated, PIVKA-II, CEA, CA19-9 were normal. CT revealed multiple tumors in the liver (S8), continuous one in the liver (S1) and pancreas, and lymphnodes (Fig. 1), which were absent one year before. She did not want further examination and died on the 17th day. Although her family did not give consent for autopsy, they agreed for needle necropsy of S8, hepato-pancreatic, and axillary tumors. The S8 tumor was diagnosed as hepatocellular carcinoma (HCC). The others showed undifferentiated tumor cells. Immunohistochemical examination showed these cells were positive for synaptophysin and CD56, but negative for low-molecular-weight keratin, high-molecular-weight keratin, CD45 and p63. Ki67 index was >80%. Thus, small cell neuroendocrine carcinoma (NEC) was diagnosed.