| Summary points: | A 36-year-old presents with 6-month history of anorexia, 20-kg weight loss, fatigue, malaise, and notable isolated elevation of cholestatic liver enzymes. This case report describes the laboratory and imaging findings, surgical procedure, and outcome, and includes some images. The authors discuss the characteristics of renal cell carcinoma and its propensity to present as a broad spectrum of nonrenal instead of typical manifestations. |