INTRODUCTION: Hepatocellular carcinoma (HCC) is a highly malignant tumor that is mostly diagnosed at an advanced stage. Here, we report a metastatic HCC in an elderly man with hepatitis C virus (HCV) and alcoholic cirrhosis. Literature is sparse on chest wall metastasis. CASE DESCRIPTION/METHODS: A 69-year-old Caucasian man presented because of a growing left chest wall mass, back pain, and weight loss for three months. He had never visited a physician before; history was pertinent for tobacco smoking and alcohol dependence. He was hemodynamically stable, cachectic on examination with a >10 cm large left upper chest wall non-erythematous firm, fixed palpable mass. Labs were pertinent for elevated liver enzymes, with ALT of 141, AST of 374, ALP of 675, normal total bilirubin, and HCV antibody positive, with an elevated viral PCR of 6.1 log IU/ml. A CT chest, abdomen, and pelvis showed a left extrapleural chest wall mass measuring 10.8 × 15.5 × 11.0 cm with erosions of adjacent ribs, destructive lytic bony lesions, and liver cirrhosis; features suspicions of metastatic HCC. Subsequent chest wall mass biopsy confirmed a moderately differentiated metastatic HCC with Immunostain positive for CAM 5.2, Hep Par, glutamine synthetase, and glypican-3. A serum AFP was elevated at 2376.15 ng/ml. Abdominal MRI demonstrated a total of five large enhancing masses with the largest measuring 4.1 × 3.5 cm with arterial enhancement, washout, diffusion restriction, and internal hemorrhage consistent with biopsy-proven HCC (LR-5). A brain and spine MRI were unremarkable except for the previously reported bony metastases. Consequently, he received localized spine and left chest wall radiotherapy, and upon completion, he was discharged home, and currently, he is on systemic chemotherapy with Lenvatinib. DISCUSSION: HCC is the second most lethal neoplasm with an 18% five-year survival. Common etiologies are HBV, HCV, alcoholic cirrhosis, and NAFLD. The most frequent metastatic locations include bones, lymphatics, and adrenals. Spread occurs heterogeneously or via a lymphatic route or by direct invasion. Extrahepatic metastasis is rare and even rarer, with poorer prognosis when the first presentation is a mass at the metastatic site. This should be in the differential of rapidly growing chest wall masses, particularly in alcoholic and/or treatment-naïve hepatitis virus-infected patients. Timely recognition of risk factors can prevent and aid early diagnosis of such aggressive tumors.Figure 1.: Chest Wall Metastasis.Figure 2.: MRI Abdomen showing the Primary Liver Lesion.Figure 3.: Pathology Slide: H & E stain showing features suggestive of HCC on a liver biopsy.