We report a case of hepatic choriocarcinoma in a man diagnosed at autopsy after a rapid downhill clinical course.The patient was a 49-year-old man who presented with acute right-sided abdominal pain.There were no masses palpable on physical examination.Radiographic findings showed large multi-nodular tumors mainly in the right lobe of the liver.Fludeoxyglucosepositron emission tomography scan showed uptake only in the liver,and no uptake in the testes.We initially planned to perform a liver resection for the presumed diagnosis of intra-hepatic cholangiocarcinoma.However,the tumors grew rapidly and ruptured.Multiple lung metastases rapidly developed resulting in respiratory failure,preventing liver resection or even biopsy.He died 60 d after initial presentation with no pathological diagnosis.Postmortem studies included histopathological and immunohistological examinations which diagnosed a primary choriocarcinoma of the liver.Primary hepatic choriocarcinoma is very rare but should be considered in the differential diagnosis of a liver tumor in a middle aged man.Establishing this diagnosis may enable treatment of the choriocarcinoma.Liver biopsy and evaluation of serum human chorionic gonadotropin are recommended in these patients. We report a case of hepatic choriocarcinoma in a man diagnosed at autopsy after a rapid downhill clinical course. The patient was a 49-year-old man who presented with acute right-sided abdominal pain. There were no masses palpable on physical examination. Ribographic findings showed large multi-nodular tumors mainly in the right lobe of the liver. Fundoxyglucosepositron emission tomography scan showed uptake only in the liver, and no uptake in the testes. We originally planned to perform a liver resection for the presumed diagnosis of intra-hepatic cholangiocarcinoma.However, the tumors grew rapidly and ruptured. Multiple lung metastases rapidly developed resulting in respiratory failure, prevented liver resection or even biopsy. He died 60 d after initial presentation with no pathological diagnosis. Postmortem studies included histopathological and immunohistological examinations which diagnosed a primary choriocarcinoma of the liver. Primary hepatic choriocarcinoma is very rare but should be c onsidered in the differential diagnosis of a liver tumor in a middleaged man. Establishing this diagnosis may enable treatment of the choriocarcinoma. Liver biopsy and evaluation of serum human chorionic gonadotropin are recommended in these patients.