Which paraneoplastic phenomenon is classically associated with renal cell carcinoma and involves non-metastatic hepatic dysfunction?

• A. Erythrocytosis due to increased EPO
• B. Hypertension
• C. Stauffer syndrome (non-metastatic hepatic dysfunction)
• D. Weight loss

Answer: (C)

The key idea here is a paraneoplastic effect of renal cell carcinoma that affects the liver without the cancer having spread to the liver. This is Stauffer syndrome. It occurs when the tumor releases cytokines, especially IL-6, which alter liver function tests even though imaging shows no hepatic metastases. Clinically you may see a cholestatic or mild hepatocellular pattern on liver tests, sometimes with hepatomegaly or fever, but the liver abnormalities improve or normalize after the tumor is removed. That reversibility after nephrectomy is a hallmark that these changes are paraneoplastic rather than due to liver metastasis.

Other RCC-related effects, like polycythemia from excess erythropoietin or hypertension from renin release, involve different organ systems and mechanisms, and weight loss is a nonspecific symptom not uniquely tied to a hepatic dysfunction pattern. The distinctive non-metastatic hepatic dysfunction points to Stauffer syndrome as the classic association.