Liver granulomas: a possible paraneoplastic manifestation of hypernephroma

A patient with hypernephroma presented with signs of liver dysfunction. Liver biopsy disclosed the presence of granulomas. Extensive search for a known cause of hepatic granulomas was negative. The presence of granulomas in lymph nodes draining the neoplasm, the improvement of liver dysfunction after nephrectomy, and its aggravation preceding overt metastatic manifestation support the existence of a cause and effect relationship between the renal cell carcinoma and the liver granulomatous disease.