INTRODUCTION: Adrenocortical Carcinoma (ACC) is an uncommon adrenal tumor with a predilection for the female population. CASE REPORT: A 55-year-old woman was referred to our attention to undergo laparoscopic cholecystectomy for symptomatic gallstone disease. She underwent a left adrenalectomy for ACC 5 years before; the follow-up was negative for relapse. During the preoperative study an Ultrasound Scanner study demonstrated a liver lesion in S6 - S7, confirmed by a Magnetic Resonance. A PET identified also a lesion on L1 vertebra. The hepatic US-guided biopsy resulted positive for ACC metastasis. After a muldisciplinary evaluation, the patients underwent a local approach to treat both hepatic and vertebral lesions. Laparoscopic cholecystectomy was performed in order to prevent biliary and pancreatic complications. The minimally invasive technique was adopted in order to reduce surgical trauma in oncological patients, even the previous abdominal surgery and percutaneous hepatic treatment. The patient is alive, with no recurrence after 12 months from local treatments. CONCLUSION: This is a very unusual case of double ACC metastases, discovered after the end of standard follow-up and locally treated. The patient is recurrence-free 12 months after these procedures. Minimally invasive approach to treat symptomatic cholecystectomy was used in order to avoid pancreato-biliary complications. This study emphasized the necessity to realize tailored protocols for the follow-up of rare neoplasia, as ACC.