Solution: This patient has both metastatic neurodendocrine tumor (adenopathy and pulmonary metastases), but also has a fatty right adrenal mass. The differential for this lesion includes: Very lipid rich adrenal adenoma, necrotic metastasis, adrenocorticocarcinoma, and lipoma/liposarcoma. However, based upon the purely macroscopic fat, metastasis, adrenocorticocarcinoma, and adenoma are very unlikely. THis patient had a CT from 7 years previously that showed only minimal growth and this is likely to represent an adrenal myelolipoma. These tumors are rare, benign neoplasms of the adrenal gland. Punctate calcification is seen in 20% of cases. It is composed of myeloid components and fat. They are benign and are usually left in place.