Background <p>Adrenal tumors are quite common. If malignancy is suspected, the question arises whether the adrenal tumor is the primary or a secondary (= metastasis) malignancy. Surgery on adrenal metastases is generally considered to be of limited value if other distant metastases exist. We present a case of laryngeal squamous cell cancer that subsequently developed a large adrenal metastasis and multiple lymph node metastases treated successfully with surgery and immunotherapy.</p> Case presentation <p>The white male patient in his 60s was treated 20&#xa0;months earlier with radiochemotherapy owing to laryngeal squamous cell cancer and considered to be in complete remission. He was now under investigation owing to macroscopic hematuria. Computed tomography showed an unrelated large left adrenal mass and periadrenal enlarged lymph nodes. A primary adrenal neoplasm with locoregional lymph node metastases was suspected. The patient underwent open adrenalectomy including removal of the locoregional lymph nodes. Histology surprisingly revealed that the large adrenal tumor was a metastasis of the laryngeal squamous cell cancer. In addition, three out of five lymph nodes removed also contained metastases of the same type of squamous cell cancer. Additional lymph node metastases (para-aortic, mediastinum, and right axilla) were subsequently diagnosed, and the patient was treated with immunotherapy. About 6&#xa0;months later, the patient was in complete remission. Immunotherapy was continued and eventually discontinued after the completion of a 2-year treatment. A total of 3 years after the adrenal surgery, the patient is still considered to be in complete remission.</p> Conclusion <p>Despite the overall bad prognosis of metastasized laryngeal squamous cell carcinoma, multidisciplinary and multimodal treatment can lead to complete remission for several years.</p>