The diagnosis of hepatocellular carcinoma (HCC) became easier in relation to the improved radiological examinations; however, the neoplasm may occur under atypical presentations mimicking other benign or malignant processes. Several mechanisms for the cystic changes of HCC have been suggested, including arterial thrombosis, inflammation, and rapid tumor growth. This paper reports an uncommon case of a 74-year-old patient, who presented with pain in the upper right abdomen and large cystic mass involving right lobe of the liver. He was diagnosed as cystic HCC, in the absence of cirrhosis, after surgery.