Sarcomatous change in hepatocellular carcinoma (HCC) is an uncommon histologic variant of HCC, characterized by the proliferation of spindle cells or bizarre giant cells. Poor outcome has been reported in most cases after diagnosis. Here, we report the first case of a sarcomatous HCC with complete central necrosis and rupture of the liver capsule. The patient received target therapy with sorafenib, but died of progressive intra-abdominal carcinomatosis 3 months after treatment. We reviewed the published reports of 13 patients with sarcomatous HCC that included computed tomography features and found that our patient was the only one to have received sorafenib. It appears that this patient's life span was not significantly prolonged with the use of sorafenib.