We report an extremely rare case of hepatocellular carcinoma accompanied by sarcoid reaction in regional lymph nodes. A 67-year-old man with chronic hepatitis C admitted for back pain had serum α-fetoprotein elevated to 60ng/ml. Abdominal ultrasonography showed a hyperechoic tumor about 4cm in diameter in segment 5 of the liver. Dynamic bolus computed tomography (CT) showed peripheral enhancement of the tumor, accompanied by enlarged lymph nodes around the common hepatic artery and the inferior vena cava. Hepatic arteriography showed tumor staining, and CT during arterioportography showed a perfusion defect, yielding a diagnosis of hepatocellular carcinoma. Transcatheter arterial embolization (TAE) of the right hepatic artery was conducted, followed by microwave coagulation therapy to the liver tumor with lymph node dissection under laparotomy. Microscopically, biopsy specimens of the liver tumor showed poorly differentiated hepatocellular carcinoma, and dissected lymph nodes involved tumor metastasis including marked epithelioid granulomas.