Hepatoid adenocarcinoma of the gallbladder antigen and carbohydrate antigen 19-9 were 2.0 ng/mL (normal ＜ 5.0) and 10.3 U/mL (normal ＜ 39), respectively. According to the pathology report from the local hospital, the lumen of gallbladder was filled with a white-gray ne- crotic mass, measuring 6 × 3 × 3 cm. The fundus of the gall- bladder revealed a mass stalk of 2 × 2 cm. There was also a shallow ulcer measuring 2 × 1.5 cm. The resection margin of the cystic duct was tumor-free. Microscopic findings showed adenocarcinoma with moderate to poor differ- entiation. The 2 × 1.5 × 1 cm tumor was polypoid, and the carcinoma invaded the subserosal connective tissue. Vascular invasion was present, but no perineural or lym- phatic invasion was seen. The patient was referred by ad- vanced stage of gallbladder malignancy. A month after cholecystectomy, a radical operation including resection of liver bed and lymph node dissection was performed. On microscopy, the parenchyma around the liver bed demonstrated chronic granulomatous inflammation, and lymph nodes around the common hepatic artery and cel- iac trunk were negative. At 14 days after radical operation, the level of AFP had dropped to 10.1 ng/mL. At 19 months after radical cholecystectomy, abdominal computed tomography (CT) showed lymphadenopathy of the portocaval area and tumor thrombi of the right por- tal vein (Fig. 1A). AFP was greatly elevated to 967.5 ng/mL. Positron emission tomography-CT revealed the hyper- Fig. 1. (A) Abdominal computed tomography (CT) revealed the necrotic lymphadenopathy with infiltration of the portocaval area and thrombosis in the main and right portal vein. (B1 and B2) Positron emission tomography/CT showed the hypermetabolic lesion of 4 × 3 cm in portocaval area. (C) The cut surface of liver showed a well demarcated mass with a central bright yellowish area in the right portal vein. thesurgery.or.kr 441