The patient presented with hirsutism, central obesity, and striae rubrae. Blood pressure measured 180/110 mmHg. Blood cortisol levels were elevated and ACTH suppressed. There was a palpable mass in the right upper and middle abdomen.
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Fig. 1 is a coronal HASTE demonstrating a large, centrally necrotic tumor displacing the right kidney and its hilum caudally.
Fig. 2 is a transverse T1 fat-saturated image following IV gadolinium. The mass exhibits an inhomogeneous peripheral enhancement pattern with central necrosis.
The MRI demonstrates a massive tumor between the liver and right kidney. The kidney is displaced caudally (Fig. 1). Following contrast, the tumor demonstrates heterogeneous enhancement with large, central necrosis (Fig. 2).
The large size of the adrenal mass and the central necrosis is compatible with adrenal cortical carcinoma.