Background: Hepatoid adenocarcinoma of the lung (HAL) is a rare type of carcinoma that histologically resembles a primary hepatocellular carcinoma (HCC), leading to a potential misdiagnosis. Clinical case: A 72-year-old man with a history of heavy tobacco smoking and recent ischemic stroke, was admitted due to hemoptysis (less than 100ml/hour), dyspnea, and pleuritic chest pain from the last month. The CT scan evinced a left hilar mediastinal lesion (<10cm), and multiple hepatic lesions. A bronchoscopy showed diffuse mucosal infiltration of the left main bronchus without active bleeding. Hepatotropic virus serology and alpha-fetoprotein were normal, and initial histology data reassembled HCC. The differential diagnosis dilemma was to determine whether it was an HCC with lung metastasis or primary lung cancer with liver metastases; however, taking into account the clinical setting and the histology features, a HAL diagnosis was made. Unfortunately, one week later after discharge, the patient had massive hemoptysis and died. Discussion: HAL is a rare type of lung cancer associated with a poor prognosis and no specific oncological treatment. Histological features resemble an HCC; hence, the diagnosis required special attention to clinical, epidemiological, imaging, and pathology data for a correct diagnosis.