An adrenal mass can be a diagnostic challenge and occasionally can be misdiagnosed with retroperitoneal tumors.

We present 3 cases diagnosed radiologically as an adrenal cortical carcinoma but histopathologically were finally proven to be a liposarcoma or leiomyosarcoma. There were 2 female patients , 82 and 49 years old , with left retroperitoneal tumors and a male patient , 49 years old with a right retroperitoneal tumor.

The first case was presented as left Adrenocortical carcinoma of 6 centimetres diameter. It was initially approached laparoscopically and then converted to an open procedure for oncologic efficacy . Left adrenalectomy and en bloc resection of the left kidney and spleen was performed. The histopathology revealed leiomyosarcoma of intermediate malignancy with origin from the left renal vein. The second case was presented as a left Adrenocortical carcinoma with 11.5 centimetres diameter . It was approached with an open technique from the start . Left adrenalectomy, distal pancreatectomy and splenectomy were performed. The histopathology showed leiomyosarcoma grade III with invasion of pancreas and spleen. The third case had a right tumor of 15 centimetres diameter , also characterised as Adrenocortical carcinoma from imaging study. It was resected with an open technique with no need of resection of other organs . It was a dedifferentiated liposarcoma (DDLPS). The postoperative course was uneventful for all patients.

Retroperitoneal liposarcomas and leiomyosarcomas are often aggressive and may present to the endocrinologist as an Adrenocortical carcinoma. Radical surgical resection with clear margins is mandatory if malignancy is suspected.