There are a number of retroperitoneal pathologies that may be confused with adrenal tumors. It is important to suspect and recognize these conditions as their management and work up might be different than adrenal tumors. This review will go in to the differential diagnosis and unique features of these conditions. A management strategy will also be provided. J. Surg. Oncol. 2012; 106:600603. (C) 2012 Wiley Periodicals, Inc.