A 58-year-old man with a right renal mass has elevated alkaline phosphatase, prolonged prothrombin time, and raised transaminases. Imaging shows a 7 cm left renal cell carcinoma with no liver metastases and no biliary obstruction. What is the most likely explanation?
- A Occult hepatic metastasis missed on imaging
- B Stauffer syndrome, a non-metastatic paraneoplastic hepatopathy ✓
- C Chronic passive hepatic congestion from tumour thrombus
- D Drug induced liver injury from analgesic use
Correct answer: B. Stauffer syndrome, a non-metastatic paraneoplastic hepatopathy
Explanation
Stauffer syndrome is non-metastatic hepatic dysfunction associated with renal cell carcinoma, characterised by elevated alkaline phosphatase, transaminases, prolonged prothrombin time, and sometimes hepatosplenomegaly without metastases. It is mediated by tumour cytokines such as IL-6 and characteristically reverses after nephrectomy, so its persistence postoperatively suggests occult spread. Imaging showing no liver deposits excludes metastasis, and there is no venous congestion described here.
Reference: Smith and Tanagho's General Urology, 19th ed.
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