Primary adrenal lymphomas are exceedingly rare. The median age at presentation is around 60 years with a male predominance. Rare cases have occurred in the setting of HIV infection or autoimmune disorders. About 50% of patients present with symptoms of adrenal insufficiency. The involvement is bilateral in about 75% of cases. Most of primary adrenal lymphomas are diffuse large B-cell type (DLBCL) (shown here). The morphologic, immunophenotypic, and genetic features are identical to DLBCLs occurring at other sites. Rare cases of peripheral T-cell lymphomas have been documented. The prognosis is extremely poor. Many cases are diagnosed only post-mortem.