A middle-aged man with end-stage renal disease presented with biopsy-proven left renal cell carcinoma (RCC) and extensive lymphadenopathy on ultrasound/magnetic resonance image. He and his family were counselled on his poor prognosis based on imaging findings, which showed multiple enlarged lymph nodes, appearing metastatic. He underwent laparoscopic radical nephrectomy along with lymph node dissection. Biopsy revealed RCC with all tuberculous lymph nodes. It was a surprise for the patient and treating clinician as the lymph node involvement was a poor prognostic factor for RCC.