Fig. 1

Radiological imaging of large adrenocortical lesions before surgery or at the time of disease recurrence. Case 1 (at time of diagnosis). Panel a) FDG-PET CT scan December 2019: The left adrenal mass is concordant with the CT scan from November. The lesion shows abnormal FDG uptake with maximum S U V is 16.2. The lesion remains highly suspicious of soft tissue metastasis from melanoma. Panel b Abdomen Pelvis CT scan April 2020: The left adrenal mass measures up to 73 mm maximum axial dimension. It is closely related to the medial aspect of the spleen where direct invasion cannot be excluded, to the left crus of the left kidney but there are thought to be thin planes of separation from these structures. No evidence of other metastatic disease.of the diaphragm and to the upper pole. Case 2 (at time of diagnosis). Panel a and Panel b) Thorax Abdomen Pelvis CT scan October 2020 – Panel b (compared to July 2020 – Panel a): Further enlargement of the isolated multicystic left adrenal metastasis, now 62.0 mm × 32.5 mm (compared to 33 × 26 mm in 3 months’ interval). The metastasis now abuts the stomach and spleen as well as the pancreas. Multi-planar reconstruction suggests the stomach rugae are lying against the metastasis rather than being invaded by it. No evidence of other metastatic disease. C) Case 3 (at time of disease recurrence). Panel a) FDG-PET CT scan and b) Abdomen Pelvis CT scan March 2015 at time of tumor progression. Evidence of lung metastases and new lymph nodes metastasis in the mediastinum