Osteolipoma is a rare lipoma-variant characterized by bone differentiation. It has the same benign prognosis of a classic lipoma, but intralesional non-fatty components require differential diagnosis from other benign and malign lipomatous entities.

An intermuscolar osteolipoma occurring in the upper neck of a 68-year-old woman is described. MRI and CT images showed a circumscribed fat-containing lesion with intralesional areas resembling teeth and bones. The histological specimen revealed foci of osseous metaplasia within mature adipose tissue, suggesting the diagnosis of osteolipoma.