Hepatocellular carcinoma with cystic formation is very rare. Only 5 cases have been reported previously in the literature. We present a 55-year-old man with a symptomatic large cystic hepatic mass. Both abdominal ultrasound and computed tomography revealed a multilocular cystic mass with solid component, occupying most of the left lobe of the liver. An extended left hepatectomy was performed on the basis of a presumptive diagnosis of a cystadenocarcinoma. Pathologic and immunohistochemical evaluation however confirmed a cystic hepatocellular carcinoma without cirrhosis. The incidence and prognosis of this rare entity is unknown.