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Lipomas, tumors of adipose tissue, are common and make up 16% of tumors of mesenchymal origin. Approximately 25% of lipomas occur in the head and neck region and are commonly found subcutaneously in places, such as the posterior neck.1 The prevalence is higher among men than women, and often arise in the fifth or sixth decade of life.2 Lipomas can further be categorized based on their histopathology into variants such as angiolipoma, chondrolipoma, spindle cell lipoma, or, in our case, osteolipoma.1An 81-year-old Caucasian male complaining of dysphagia associated with weight loss of 2 years duration was referred to the otolaryngology office after magnetic resonance imaging (MRI) of the brain demonstrated a hyperintense retropharyngeal mass with smooth margins measuring 4.46 cm × 2.35 cm in sagittal view (see Figure 1). The MRI was originally ordered for cognitive complaints.