A lobulated heterogeneous mixed echogenicity lesion (containing both solid and cystic components) measuring 8 x 9 cm approximately is seen in the left hypochondrium between the upper pole of left kidney and spleen. No significant vascularity is seen within it on colour Doppler ultrasound examination.

A sizeable complex lobulated mass lesion measuring 11 x 10 x 9 cm is seen in the left suprarenal region. It shows mild heterogeneous enhancement at the periphery and a large central necrosis. No calcifications are seen in it. The lesion is epicentered in the left adrenal gland, infiltrating the upper pole of the left kidney and left crus of the diaphragm, is in close contact with splenic hilum, fundus of the stomach and descending colon and displacing the splenic vein and tail of the pancreas anteriorly. Its vascular supply is from left adrenal and left renal arteries and venous drainage is into the patent and well-opacified left renal vein. Mildly thickened Gerota's fascia. Aorta and IVC are normal. No intraspinal extension is noted. Right adrenal is normal. A few simple bilateral renal cysts are seen. Prostatomegaly. Normal looking subhepatic appendix.

There is no abnormal increased MIBG activity throughout the whole body particularly in the left suprarenal region. Physiological radiotracer distribution seen in the salivary glands, thyroid, liver and urinary bladder.

Histopathology showed adrenal cortical carcinoma (oncocytic type), invading into the left kidney and peri-adrenal & peripancreatic adipose tissues. No metastasis noted in the regional lymph nodes.