The presence of macroscopic fat in an adrenal mass has classically been associated with myelolipoma. Adrenocortical carcinoma is typically an aggressive malignancy with a poor prognosis. The presence of macroscopic fat is not a characteristic finding in adrenocortical carcinoma or other adrenal malignancies. We report a case of a newly discovered large adrenal mass containing multiple areas of macroscopic fat, which was pathologically proven to represent an adrenocortical carcinoma.