A case of uterine lipoleiomyoma in a 72-year-old woman is presented. Although a series of imaging studies suggested a lipomatous tumor, diagnosis was difficult because the tumor appeared as a pedunculated mass extending from the uterine body. To distinguish the tumor from an ovarian lipomatous tumor, the "beak sign" in a magnetic resonance imaging study was diagnostic in this case. The purpose of this paper is to review lipomatous masses of the female pelvis, to discuss the differential diagnosis of the unusual imaging features, and to discuss imaging techniques to optimize pelvic mass characterization.