ABSTRACT Cardiac metastases are a rare site for metastatic hepatocellular carcinoma (HCC). We describe an atypical presentation of an isolated right ventricular metastasis of HCC following successful treatment with no evidence of primary disease recurrence. The case presented as gradually worsening hypertension and erythrocytosis in the setting of normal surveillance scans and alpha‐fetoprotein levels. The mass was detected on transthoracic echocardiogram and treated with surgical resection. Histopathological features of the tumor demonstrated features associated with WNT/β‐catenin mutated HCC, such as microtrabecular, acinar, and bile staining with positive glutamine synthetase expression.
