A 74-year-old, postmenopausal woman presented to her urologist with complaints of urge incontinence. Her medical history consisted of a sectio, diabetes mellitus, hypertension and hypercholesterolemia. Clinical examination showed a cystocoele. A bladder and renal ultrasound was performed during consultation revealing right hydronephrosis grade 2 and left hydronephrosis grade 1 (not shown). The bladder was normal. Incidentally a fluid-containing structure was noted measuring 10 cm in diameter (not shown). CT urography showed a cystocoele and a right distal ureteral stone (dotted arrow), explaining the hydronephrosis (Fig. A). The left ovary showed a large septated cystic mass, matching the ultrasound finding (Fig. B, dotted arrow). Furthermore a well-circumscribed, predominantly fatty mass was discovered in the uterus with dimensions of 42 x 34 x 36 mm (Fig. A,B, arrow). MRI T1-weighted images showed a well-defined, uniformly high-intensity uterine mass with discrete septae (Fig. C, arrow). The mass suppressed on the fat-saturated images (Fig. D, arrow). MRI additionally showed the intramural location of the uterine mass and confirmed the thin septae in the cystic mass of the left ovary (not shown). Based on these findings the diagnosis of uterine lipoleiomyoma and mucinous cystadenoma of the left ovary was made. A hysterectomy and adnexectomy was performed. Pathology of the uterine mass revealed 98% mature fat with sporadic areas of well-differentiated smooth muscle cells (Fig. E, F). No mitotic activity was reported. These findings are consistent with a lipoleiomyoma, almost entirely composed of lipocytes. The right adnexal mass consisted of a mucinous cystadenoma.