Sarcomatoid hepatocellular carcinoma (SHC), which contains variable proportions of sarcomatous and carcinomatous components, is a rare variant of hepatocellular carcinoma and is a special variant of hepatocellular carcinoma. It is highly malignant, progresses rapidly, and has an extremely poor prognosis. However, the molecular pathogenesis of SHC remains unknown. We report a case of a 35-year-old male, previously healthy with no liver disease history, who presented with intermittent fever. Imaging examination during hospitalization revealed focal liver lesions. Without obvious surgical contraindications, right hemihepatectomy, cholecystectomy, and regional lymph node dissection were performed. Postoperative pathology and immunohistochemistry confirmed the diagnosis of SHC. However, due to the financial burden of the disease, the patient and his family chose traditional Chinese medicine as postoperative supplementary treatment rather than targeted drug combined with immunotherapy or other adjuvant therapies. Unfortunately, the patient passed away due to tumor recurrence 8 months after surgery.