Glypican-3 is a proteoglycan that is overexpressed on the surface of hepatocellular carcinoma (HCC) cells (1,2). Recently, [68Ga]Ga-RAYZ-8009 was introduced as a promising PET tracer for HCC imaging that may overcome the limitations of the imaging modalities currently used (3–5). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from the patient. We report on a 72-y-old woman with a moderately differentiated HCC (initial a-fetoprotein, 50.8 ng/mL; Barcelona Clinic Liver Cancer stage A; Child-Pugh class A). After initial diagnosis and successful image-guided thermal ablation of the 2-cm lesion in 2020, the results of subsequent oncologic follow-up, including regular serum a-fetoprotein, MRI, and CT, were unremarkable. At the end of 2024, a continuous increase in serum a-fetoprotein (as high as 117 ng/mL; reference value, 7 ng/mL) was observed. However, morphologic imaging (CT and MRI) did not detect any evidence of tumor recurrence or metastases. Because of a continued rise in the patient’s serum a-fetoprotein level, the patient underwent PET/CT 120 min after receiving 165 MBq of [68Ga]Ga- RAYZ-8009. PET/CT images demonstrated several tracer-avid peritoneal lesions (up to 8 mm; Figs. 1A–1C, blue arrows), consistent with HCC metastases. The diagnosis of peritoneal carcinomatosis was confirmed by laparoscopy and subsequent histologic and immunohistochemical examination of tissue samples, which showed glypican-positive disease (Figs. 1D–1F). On the basis of these results, systemic therapy with bevacizumab and atezolizumab was initiated. To the best of our knowledge, this is the first report of extrahepatic HCC manifestations detected by glypican-3–directed PET/CT. Future studies are warranted to investigate the added value of [68Ga]Ga- RAYZ-8009 PET/CT for the diagnostic management of HCC and assessment of treatment response. Additionally, glypican-3–directed radiopharmaceutical therapy using 177Lu- or 90Y-labeled RAYZ- 8009 may become a treatment option for advanced HCC. DISCLOSURE The precursor was provided by RayzeBio, Inc. Constantin Lapa reports prior consulting activities for Blue Earth Diagnostics Ltd. and Novartis. Ralph Bundschuh is a consultant for and has received speaker’s honoraria from Bayer Healthcare, Novartis, Terumo GmbH, and Eisai GmbH and has received travel expenses from Blue Earth Therapeutics. Helen Scholtissek received travel support from Boston Scientific Medizintechnik GmbH and Terumo GmbH. No other potential conflict of interest relevant to this article was reported.