Extra-adrenal myelolipoma in the pelvis: A great mimicker of liposarcoma

Myelolipomas are rare, benign tumors composed of adipose tissue and hematopoietic cells, most commonly found in the adrenal glands. Extra-adrenal occurrences are exceptionally rare and can mimic other fat-containing tumors like liposarcomas, presenting a diagnostic challenge. We present a case of an 88-year-old female with an incidental finding of a large presacral fat-containing mass on computed tomography (CT) that raised suspicion for liposarcoma. Considering the common differential diagnoses associated with myelolipomas, coordinated multidisciplinary efforts between clinical, pathological, and radiological teams must be prioritized to rule out potentially aggressive tumors. This case highlights the importance of advanced imaging coordinated with pathological and clinical findings for timely and accurate diagnosis. Overall, the prognosis for these tumors remains excellent with appropriate monitoring.