A woman presented to surgeons with abdominal discomfort in 1990. She underwent abdominal computed tomography, which showed a large incidental right suprarenal mass (fig 1⇓). Follow-up scans suggested a benign stable adenoma, measuring 49×60 mm, and the decision was made not to operate. An endocrine opinion was not sought. Her medical history included hypertension.

In June 2006, at the age of 69, she re-presented with peritonitis, and a laparotomy showed a thickened wall cyst at the duodeno-jejunal junction. During elective excision of the cyst in April 2007, it was difficult to achieve haemodynamic stability. An unplanned resection of the suprarenal mass was performed concomitantly. The cyst stained strongly positive for CD117. Figure 2⇓ shows the patient’s clinical features.