A 61-year-old white woman experienced progressive right flank pain over a 6-month period. Cross-sectional imaging (computed tomography [CT] of the abdomen and pelvis; MR venogram) demonstrated a 10.9 x 9 x 8.4 cm right adrenal mass with concern for liver invasion and inferior vena cava involvement. Her metastatic workup was negative. She underwent an adrenal metabolic workup that revealed normal plasma metanephrines. A CT-guided biopsy revealed a poorly differentiated primary small cell carcinoma of the adrenal gland.

Figure 1. MRI scan of the abdomen with intravenous contrast. There is re-demonstration of a large heterogeneous mass in the region of the right adrenal gland. This measures 10.4 x 8.4 x 8.5 cm. The mass is inseparable from the adjacent right hepatic lobe as well as the right kidney upper pole. The mass is inseparable from the posterior aspect of the intrahepatic IVC as well as the remainder of the proximal IVC. The mass is also inseparable from the right renal vasculature and from the medial aspect of the right diaphragm as well as the adjacent lumbar vertebral bodies.
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