We encountered a case of hepatocellular carcinoma (HCC) with macroscopic biliary tumor thrombus, which was a rare manifestation of HCC that simultaneously showed rim calcification and no arterial-phase enhancement. A 67-year-old woman was admitted with back pain. Enhanced computed tomography revealed a hypodense hepatic tumor surrounded by rim calcification, and a dilated left hepatic duct containing dense material indicating tumor thrombi. Magnetic resonance imaging showed fat deposition in the main part of the tumor. Malignancy was strongly suspected because of the tumor thrombus and elevated PIVKA-II, left hepatic lobectomy was performed. Subsequent pathological examination revealed a moderately differentiated HCC invading into the left hepatic duct. It is well known that HCCs can show variety of imaging features. In this case, however, triple atypical features were observed simultaneously; those were macroscopic biliary tumor thrombus, no arterial-phase enhancement and rim calcification. We discussed how these unusual radiological images could be seen through comparing with pathological features
