Adrenal cysts are rare benign entities that commonly masquerade as more serious illnesses. They are usually asymptomatic and non-functional. Here, we present a case of a large left adrenal cyst of size 10.8 × 10.2 × 7.8 cm in a 25-year-old male, who initially presented with fever and abdominal pain, with clinical suspicion of an abdominal malignant neoplasm. Laboratory workup was unremarkable, while the histopathological diagnosis was that of a benign true adrenal cyst – epithelial type. This case report highlights the rarity of cysts larger than 4 cm, radiological and pathological features for appropriate diagnosis, as well as subclassification of the cyst, which is essential to institute optimal treatment.
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