A 72-year-old female with hypertension received regular treatment at our cardiovascular outpatient department. After six years of treatment, she complained of left upper quadrant abdominal pain that had been occurring occasionally for five months. Sonography of the abdomen revealed a 5.6 cm left suprarenal mass. Furthermore, magnetic resonance imaging showed a large irregular heterogeneous left adrenal enhanced mass, measuring approximately 5.4 × 4.5 cm with central necrosis. Based on suspected pheochromocytoma, daVinci robotic-assisted laparoscopic en bloc resection of the left adrenal tumor was performed. Diagnosis of stage I (≤5 cm) adrenal cortical carcinoma (ACC) was made based on microscopic diagnostic criteria of Weiss score along with immunohistochemical stain findings (positive for Melan A and synaptophysin and negative for chromogranin). ACC is a rare malignant adrenal cortex tumor. Here we report an ACC case and review the literature.