The authors evaluate the role of surgery in the treatment of primary adrenocortical cancer. They describe a case-report of a “giant” surrenalic cancer in a young woman affected by chronic hepatatis B related, submitted to “en bloc” surgical resection, locoregional lumphectomy and omolateral nefropexy. The adjuvant post-operative therapy consisted in six cicles of chemioterapy with Mitotane (op’DDD) at conventional dose. Postoperative course was unevenful and the patient was discharged after four days. Postoperative adjuvant therapy was well tolereted and after one year the patient is disease free. In Italy adrenocortical cancer represents about the 10% of adrenal neoplasms and causes a mortality – cancer related – about of 0.1% among all cancers. The incidence of relapse is about 25% after “en bloc” resection with 5 years survival of 54% in stage I-II, 21.4% in stage III, 6.5% in stage IV, respectively. The age <40 years a functional activity of the mass, stage and resecability of neoplasm represent the most important prognostic factors. The use of mitotane in the postoperative adjuvant therapy is still controversery with variable results. Surgery represents the tratment of choice in case of primary adrenocortical cancer and is well indicated also for patients with advanced stage and recurrent loco-regional disease.