This patient presented with Cushing’s syndrome and hypertension. CT scan revealed a 12.5 cm left adrenal mass. It turned out to be adrenocortical carcinoma. Adrenal tumors this large (12.5 cm) are rarely benign. Adrenal adenomas rarely exceed 5 cm or 50 grams. Note the mitotic figure – another feature that is usually missing in adenomas.