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Abstract Macrotrabecular‐massive hepatocellular carcinoma (MTM‐HCC) is a subtype of HCC with a very poor prognosis and exhibits biological behaviors and clinical presentations that distinguish it from conventional HCC. Vessels encapsulating tumor clusters (VETC) is a unique pattern of vascular growth that is more common in patients with MTM‐HCC. This unique interaction between the angiogenic system and tumor cells is of general interest. Early diagnosis and appropriate treatment of HCC with MTM and VETC patterns help prevent early recurrence and improve prognosis. This review summarizes the existing findings for HCC with MTM and VETC patterns.