A 51-year-old male was admitted to our hospital with chief complaints of anorexia and fatigue of 2 mo duration. In February 2018, the patient felt anorexia and fatigue without any apparent inducements, accompanied by a weight loss of 5 kg during 2 mo. Routine blood tests showed no abnormalities, while biochemical tests showed albumin (ALB) level of 32 g/L, total bilirubin (TBIL) level of 23.3 µmol/L, and prothrombin time (PT) of 13.9 s, which were all abnormal. Besides, alpha-fetoprotein (AFP) level was significantly higher than the expected value (8875 ng/mL). Ultrasonography showed multiple lesions in the liver, of which the largest one was about 10 cm in the left lobe of the liver, and tumor thrombus was expanded into the portal vein. The dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) revealed a 10.6 cm × 8.3 cm mass in the left lobe of the liver, and multiple metastases were found in the right lobe of the liver. Tumor thrombus was detected in the inferior vena cava and major portal vein. The patient had a history of chronic hepatitis B virus (HBV) infection for 20 years, and underwent regular antiviral therapy with Entecavir that reduced HBV-DNA level to the normal range. No special notes. The abdominal examination revealed epigastric tenderness. The patient’s body temperature was 38.3 °C, with blood pressure of 130/85 mmHg, heart rate of 93 beats per min, respiratory rate of 18 breaths per min, and oxygen saturation on room air was 99%. Routine blood tests showed no noticeable abnormalities, and biochemical tests showed ALB of 32 g/L, TBIL of 23.3 µmol/L, and PT of 13.9 s, which were all abnormal. The DCE-MRI revealed a 10.6 cm × 8.3 cm mass in the left lobe of the liver, and multiple metastases were found in the right lobe of the liver. Tumor thrombus was detected in the inferior vena cava and major portal vein.