Myelolipomas are benign neoplasms composed of mature adipose tissue and hematopoietic elements. The incidence is 0.06% to 0.2%1 at autopsy. Most myelolipomas arise from adrenal glands; however, they can arise extra-adrenally from presacral tissue, retroperitoneum, muscle fascia, mediastinum, stomach, and liver. Most myelolipomas are discovered incidentally and are small, solitary, and asymptomatic. They are usually unilateral but occur equally on each side. Occasionally, they can be bilateral and multifocal or can grow to giant proportions such as this one. The tumors are circumscribed but not encapsulated. The gross appearance varies from yellow to red-brown, depending on the proportion of myeloid cells. On microscopic examination, they are composed of mature adipose tissue and hematopoietic cells. Occasionally, foci of bony metaplasia, infarction, and hemorrhage can be seen.