case_images: PMC9946273_01
case_images: Computed tomography (CT) scan of the abdomen demonstrating incidentally noted adrenal mass.. White circle: Large irregular right-sided adrenal mass with foci of heterogenous internal enhancement noted
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case_images: PMC9946273_01_cureus-0015-00000034099-i01.jpg
case_images: FIG1
case_images: A CT angiogram to exclude aortic dissection revealed a large right adrenal lesion with foci of heterogeneous internal enhancement measuring 5.0 cm x 3.7 cm (Figure 1).
case_images: Hematoxylin & eosin stain of a section of tissue from pathologic biopsy under high power microscopy. Noted are the increased number of mitotic figures, increased nuclear:cytoplasmic ratio, and abnormal mitotic figures typical for a high-grade malignancy,
case_images: cureus-0015-00000034099-i02.jpg
case_images: PMC9946273_01_cureus-0015-00000034099-i02.jpg
case_images: FIG2
case_images: The primary tumor was staged T2, with a mitotic rate of 22/50 high power fields that marked it as high grade histologically (Figure 2). 
case_images: CT of the chest demonstrating multiple nodules in the lungs consistent with metastatic disease progression.. Green lines: Identified lung parenchymal nodules measuring 2.60 cm (panel 1) and 2.24 cm (panel 2) in greatest diameter.
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case_images: PMC9946273_01_cureus-0015-00000034099-i03.jpg
case_images: FIG3
case_images: Repeat imaging, in the setting of worsening fatigue and anorexia, confirmed enlargement of her multiple lung nodules with a new soft tissue mediastinal mass also being found (Figure 3).