Serum Cholesterol Level and Hepatoma

To the Editor.—  In their interesting and important study, Winawer and colleagues¹ conclude that individuals in whom colorectal cancer develops share the same level of serum cholesterol as the general population initially but demonstrate a decline in serum cholesterol level prior to the diagnosis of cancer. As clinicians, we believe that the other intriguing association between serum cholesterol level and gastrointestinal malignancy is the development of hypercholesterolemia in patients with hepatoma as demonstrated by one of our patients seen recently at West Side Veterans Administration Medical Center.

Report of a Case.—  In September 1988, a 34-year-old black man had a serum cholesterol level of 5.00 mmol/L (193 mg/dL) (normal level, 3.10 to 5.70 mmol/L [120 to 220 mg/dL]) documented as part of his routine serum biochemistry tests. There was no history of familial hypercholesterolemia. He occasionally drank alcohol excessively but otherwise had been healthy until August 1989, when he