Percutaneous and intraoperative radiofrequency ablations (RFA) of hepatocellular carcinoma (HCC) are widely used treatment methods. EUS-guided RFA has recently been used for pancreatic tumors, whereas, to our knowledge, there are no reports of EUS-guided RFA for HCC. We present the case of a 75-year-old man with hepatitis C virus–related cirrhosis who, in May 2015, underwent percutaneous RFA for an HCV-related HCC in the VIII liver segment. The patient was in good clinical condition until June 2017, when a follow-up abdominal MRI showed a 25- × 20-mm hypovascular lesion of the III liver segment (Fig. 1A).