The adrenal mass has an appearance which could also represent adrenal metastases or pheochromocytoma . However, the large size at presentation, the absence of functional activity, the invasion of the IVC, and the unilaterality, all favor adrenal cortical carcinoma.
Most adrenal carcinomas are >5 cm at presentation and may either be functioning or "silent". Some surgeons prefer not to biopsy large primary adrenal tumors due to a theoretical risk of tumor seeding.