Abstract
Hepatocellular carcinoma is an aggressive tumor that typically metastasizes to the lungs, abdominal lymph nodes, and bones. The presence of mediastinal lymph node metastases is a rare and unusual clinical situation, associated with a poor prognosis. We report the case of a patient with cirrhosis secondary to treated hepatitis C, in whom hepatocellular carcinoma was discovered without extrahepatic spread, except for the presence of mediastinal lymphadenopathy. Biopsy of these nodes, performed via endoscopic ultrasound-guided fine needle biopsy through the oesophagus, confirmed that they were indeed metastatic mediastinal lymph node metastases from HCC. This finding shifted the therapeutic approach from curative treatment to systemic therapy.