An eight-year old male patient presented to a GP clinic due to constipation and soiling. During his workup an abdominal ultrasound was done and revealed a right-sided supra-renal mass, and therefore he was referred to us for further assessment.

His CT scan showed a large heterogeneously enhancing soft tissue mass with a large central area of necrosis and foci of calcification seen in the right suprarenal space, which appears to push the right kidney inferiorly with suspicious invasion of its upper pole. It also exerts mass effect at the posterior aspect of the right hepatic lobe as well as the IVC with no definite invasion. There are multiple enhancing soft tissue nodules seen at the posterior right perinephric space with mild surrounding fat stranding suggestive of the infiltration by the mass.

A few metastatic pulmonary nodules were also noted.

Wedge resection of 2 nodules confirmed the diagnosis of adrenocortical carcinoma.

His labs showed a normal hormonal profile.