Myelolipoma is an uncommon benign tumor that classically arises in the adrenal glands. Most cases are asymptomatic, with incidental detection of this tumor on cross-sectional imaging performed for other causes. Extra-adrenal occurrence of myelolipoma has been infrequently reported, with scarce radiology literature on the topic. We present radiologic and pathologic correlation in two cases of image-guided biopsy proven extra-adrenal myelolipoma in the presacral and paraaortic location, with review of literature.