Hepatocellular carcinoma (HCC) is a common cancer presenting in adults with an increasing incidence in the United States. The many etiologies of cirrhosis place patients at increased risk for developing hepatocellular carcinoma but not all patients who develop this cancer have underlying cirrhosis. Presented is a case of a man without cirrhosis or any known risk factors for liver disease who was admitted in fulminant hepatic failure. He was found to have hepatocellular carcinoma complicated by an extensive tumor thrombus. At autopsy, underlying hemochromatosis was discovered. The etiologies, clinical manifestations, diagnostic modalities and treatment options are discussed patients with hepatocellular carcinoma.