The paraneoplastic syndrome of hepatocellular carcinoma has been reported to include hypercholesterolemia, hypoglycemia, hypercalcemia and polycythemia. However, any case in which hypercholesterolemia and hypercalcemia are appeared together as paraneoplastic syndrome of the patient with hepatocellular carcinoma has not been reported. A 62-year-old female patient was admitted to our hospital because of general weakness, easy fatigue, anorexia, ascites and weight loss. On admission, abdominal ultrasonogram and computed tomography showed multiple variable sized hepatocellular carcinoma in the both lobes with underlying liver cirrhosis. The serum calcium level was 11.2 mg/dL and total cholesterol level was 576 mg/dL. Bone scan showed no evidence of bone metastasis. Intact parathyroid hormone level was decreased (0.1 pg/mL) and parathyroid hormone related peptide (PTHrP) level was increased (283.0 pmol/L). The lipid profiles were as follows: total cholesterol, 576 mg/dL; triglyceride, 213 mg/dL; HDL-cholesterol, 10 mg/dL; LDL-cholesterol, 523 mg/dL. Lipoprotein electrophoresis showed type IIa of hyperlipidemia and after 2 weeks, follow-up lipoprotein electrophoresis showed lipoprotein-X pattern. We report a very rare case of hepatocellular carcinoma with both hypercholesterolemia and hypercalcemia as paraneoplastic syndrome. (Kor J Gastroenterol 1999;34:271 - 276)