Objective To investigate the relationship between changes of vascular elasticity and spontaneous rupture of hepatocellular carcinoma (HCC). Methods We examined the semiquantitatively expression of related angiogenesis factors including von Willebrand factor, elastin and neutrophil elastase in 30 specimens of HCC with spontaneous rupture by immunohistochemistry compared with 30 specimens of HCC without rupture. Results The results showed that there was a significant decrease of von Willebrand factor, overproliferation of elastin and abnormal distribution of neutrophil elastase around the small artery in ruptured HCC. These changes exacerbated weakness of the blood vessels and destroyed function of coagulation. The blood vessels split easily when the vascular load increased from hypertension or minor mechanical trauma. Conclusion The spontaneous rupture of HCC may be related to the vascular dysfunction.