We report the MRI findings of primary small-cell carcinoma of the kidney (PSCCK) in a 59-year-old female. This tumor appeared as a 16-cm mass that arose from the right kidney. This lesion had diminished signal on T1-weighted images and heterogeneous mixed signal on T2-weighted images. The tumor primarily involved the renal medulla with persistent thin renal cortex. Despite the tumors' large size, no substantial central necrosis was present. The predominant medullary location and the lack of central necrosis in this large tumor were features unusual for renal cell carcinoma and should raise the suspicion of another malignancy, the differential diagnosis of which should contain extrapulmonary small-cell carcinoma of the kidney.