A biopsy of the abdominal mass was performed in another center, revealing neoplastic cells of epithelial origin characterized by moderate nuclear pleomorphism, negative at the immunohistochemistry for PAX-8, TTF-1, and chromogranin, positive for cytokeratin AE1/AE3, cytokeratin 7, calretinin, inhibin, synaptophysin, and melan A. These features were compatible with the diagnosis of primary ACC, so the patient was addressed to the Medical Oncology Unit at Spedali Civili as a reference center. This evidence concerns the gene TTF1 and adrenal cortex carcinoma.