Inguinal hernias are common diseases, but malignant lesions in groin hernias are rare; metastatic hepatocellular carcinoma (HCC) in the hernia sac is extremely rare. We report a 72-year-old man who had advanced stage HCC with portal vein invasion and multiple metastatic lymphadenopathies. He presented a painless palpable mass in the right groin. Computed tomography scan showed a contrast-enhanced soft tissue mass (2.8 cm in size) at the right herniated inguinal sac. Tumor excision and hernia

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... air were performed, and the histopathological examination revealed metastatic HCC. After being stabilized from surgery, the patient received combination therapy with sorafenib and nivolumab; however, he still died of rapid tumor progression and liver decompensation 1 month later. This case raises clinical awareness of unusual extrahepatic metastases of HCC, especially for patients at an advanced tumor stage. K E Y W O R D S extrahepatic metastasis, groin mass, hepatocellular carcinoma, inguinal hernia