A 32-year-old man presented with long-standing low back pain that worsened in the last few days, as well as a loss of thirty pounds of body weight over a period of approximately three months. No symptoms and signs of adrenal hyperfunction were detected.

On abdominal examination, a hard tumour was palpated in the left hypochondrium reaching the mesogastrium and left iliac fossa. The imaging studies performed were: abdominal ultrasound, chest X-ray, descending urogram and computed axial tomography.

No metastases were detected in the chest X-ray. The findings obtained in the other imaging studies indicated the presence of an extensive, well-demarcated mass with regular contours and heterogeneous signs suggestive of haemorrhagic and necrotic areas. There was displacement of neighbouring structures with infiltration. No infiltration of the liver or inferior vena cava was demonstrated. Treatment consisted of surgical excision via the thoraco-abdominal route with clamping of the thoracic aorta to control transoperative haemorrhage. In addition to resection of the tumour, a left nephrectomy and en bloc splenectomy with hilar adenopathy bundles were performed.

The excised tumour was well encapsulated, weighing 4350 g and with a maximum diameter of 24 cm. Macroscopic examination showed a solid mass with haemorrhagic areas. The tumour infiltrated the capsule and the perirenal fat of the entire upper pole of the left kidney as well as the spleen. Histological examination revealed a diagnosis of adrenal gland carcinoma. The postoperative course was satisfactory and the patient was discharged on the tenth day after surgery. Survival was six months. Death occurred due to disease progression.