| Summary points: | A 73-year-old man with hepatitis B-related liver cirrhosis presents to the emergency room with a 2-day history of right upper abdominal pain and fever. Vital signs on arrival, medical history, including treatment for primary hepatocellular carcinoma (HCC), physical examination, laboratory data, abdominal echogram, computed tomography, open cholecystectomy, operative findings, and pathologic examination are described; images provided. The authors discuss their rare diagnosis of metastatic gall bladder carcinoma from HCC. |