Comprehensive reviews * concerning the clinical features of primary carcinoma of the liver have emphasized the difficulty in establishing the antemortem diagnosis of this visceral neoplasm. The clinical manifestations of hepatic carcinoma in most patients are similar to those encountered in hepatic cirrhosis, biliary tract disease, or malignant neoplasms of other organs. This is illustrated by the frequent occurrence of abdominal pain, ascites, peripheral edema, splenomegaly, jaundice, weakness, anemia, and weight loss. The diagnostic significance of such symptoms is further minimized by the high incidence of cirrhosis in patients with hepatic carcinoma. Pyrexia and intra-peritoneal hemorrhage have been observed as the initial manifestations in some patients. The occurrence of hematemesis and melena has been emphasized by Edmondson and Steiner, who noted such phenomena in 12% of the cases which they reviewed. Occasionally a palpable hepatic mass may indicate the presence of hepatic carcinoma, but other physical findings which might be considered