In the United States and Western Europe, primary hepatocellular carcinoma is an uncommon malignancy. Even though many well-defined associations have been reported, paraneoplastic manifestations are rare in North American patients. We describe an adolescent with complaints of weight loss, weakness, and a sensation of “fullness in the upper abdomen.” On initial laboratory workup a lactescent serum was found, with the following abnormalities: serum cholesterol level of 573 mg/dl (normal 120-260), triglycerides of 1,761 mg/dl(normal 10-190), and serum thyroxine level of 21 ng/dl (normal 5.5-12.3). Serum albumin, calcium, and thyroid-stimulating hormone levels were also minimally elevated. Liver biopsy confirmed hepatocellular carcinoma. This is a rare hepatoma, which in our case manifested with multiple paraneoplastic phenomena, including, Hypertriglyceridemia hypertriglyceridemia, and hypertriglyceridemia. We review the pertinent literature.