Adrenal masses, particularly clinically unapparent ones, are being detected with increasing frequency due to the widespread use of sophisticated imaging techniques performed for conditions that are not related to adrenal diseases. The radiographic finding of a cystic adrenal gland usually leads to an adrenal biopsy or resection. The pathologist must distinguish between benign cysts and cystic presentations of primary adrenal tumors. This review focuses on morphology, pathogenesis, and ancillary testing results of cystic masses of the adrenal gland and also discusses their pathologic differential diagnosis.