Right hypochondrial mass lesion, likely arising from the right adrenal gland. Other possibility can be exophytic hepatic lesion or exophytic duodenal mass lesion like GIST.

The patient underwent surgery (laparotomy and right adrenalectomy).

Histopathology: Right adrenal adenoma (measuring 8 x 6 x 4 cm). The immunostain with the antibody anti-Cytokeratin AE1/AE3, Synaptophysin, Vimentin, Inhibin, CD56, Calretinin, CK (CAM5.2) is positive. The immunostain with the antibody anti-S100, NSE, BCL2, HMB45 and Chromogranin are negative. The immunostain with the antibody anti-Melan-A is diffusely positive in tumor cells.  Immunostain with the antibody anti-neurofilaments is negative. The proliferation index Ki67 is very low (<5%).

Comment: The application of the Weiss Criteria showed the following scoring:  Vein invasion score: 0. Capsular invasion score: 0. Nuclear grade score: 0. Mitosis (< 2 mitoses/50 HPF) score: 0.  Sinusoidal invasion score: 0.  Necrosis score: 0.  Atypical mitosis score: 0.  Diffuse architecture score:1.  Clear vacuolated cells (<25%) score: 1.  Total score: 2. According to the score, the tumor is classified as adenoma (benign) (Score <3).