Background: The appearance of hepatocellular carcinoma in non-cirrhotic livers is uncommon. Material and Method: We report a 62 years old woman presenting with a liver mass that was subjected to a left hepatectomy. Results: The pathology report disclosed a poorly to moderately differentiated hepatocellular carcinoma. The surrounding liver tissue was normal. Immunohistochemistry identified intracytoplasmic alpha-1 antitrypsin granules, confirming the suspicion of alpha-1 antitrypsin deficiency.