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Please write a short note on the methodological approach used and its benefits. **Case Description:** The authors describe a case of a 71 year old female patient who had undergone an open laparotomy and cholecystectomy in 2014. One year after the surgery she had been diagnosed with left adrenal metastases. A follow-up MR examination was scheduled for 2017, but the patient was lost to follow-up. In 2016 she was re-presented to the hospital with a short history of abdominal pain, nausea, and vomiting. An ultrasound examination showed a large abdominal mass and enlarged lymph nodes. The patient was diagnosed with an advanced stage IV disease, with peritoneal carcinosis, and metastases of the liver, kidneys, bone, and lung. Abdominal computed tomography (CT) and positron emission tomography (PET) confirmed the diagnosis and showed a large tumour of 5.5 cm in diameter. The patient was referred to our Department of Surgical Oncology. **Analytical Approach:** A detailed analysis of the patient's medical history was carried out. The clinical, laboratory, and imaging findings were analyzed. **Main Results:** The patient's pre-operative condition was characterized by a large left adrenal tumour of 5.5 cm in diameter. An ultrasound examination had previously performed and showed a large mass in the left adrenal. The mass caused massive compression of the surrounding structures. CT and PET showed enlarged lymph nodes and peritoneal carcinosis. The patient was referred to our Department of Surgical Oncology. Histology confirmed the presence of adrenal carcinoma. She was initially treated with a standard regimen of mitotane (no more than 7 weeks). This treatment was associated with substantial clinical improvement, along with a decrease in the size of the adrenal mass and the accumulation of ^18^F-FDG in the tumour. **Significance:** Adrenocortical cancer is a rare malignancy that accounts for 0.45% of all cancer cases, and it is responsible for 2.3% of deaths. The most common symptoms of the disease are hormonal disorders or mass in the adrenal glands. Diagnostic procedures include physical examination, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and ^18^F-fluorodexyglucose (FDG) PET. The standard treatment for adrenocortical 847798691e