Abstract: Objective To investigate the clinical features, diagnosis and treatment of primary hepatocellular carcinoma (HCC) with splenic metastasis. MethodsRetrospective analysis was performed using clinical data from 1 primary HCC patient with splenic metastasis. Meanwhile, related literatures was reviewed to investigate its differential diagnosis and treatment progress. ResultsThis patient was admitted due to bellyache, and abdomen CT showed irregular mass in both the liver and spleen. Percutaneous fine-needle biopsy of the tumor in spleen was performed, and the diagnosis of primary HCC with spleen metastasis was confirmed. The patient was is in Stage cT4NxM1, Phase ⅣB. Then, optimal supportive care was administered, and the patient was discharged two months later. ConclusionsPrimary HCC with splenic metastasis is rare, and palliative treatment can be adopted after pathological diagnosis.