Pelvic tumors that contain fat are common findings in women. Although the majority of these lipomatous tumors are benign cystic ovarian teratomas, other diseases should be considered in the differential diagnosis: malignant degeneration of a benign cystic ovarian teratoma, nonteratomatous lipomatous ovarian tumors, lipomatous uterine tumors, benign pelvic lipomas, and pelvic liposarcomas. Although these diseases are rare, their differentiation can be clinically significant. While most of these tumors are treated by surgical excision, asymptomatic lipomatous uterine tumors and benign pelvic lipomas may require no therapy. Additionally, correct identification of a malignant lipomatous tumor will affect both prognosis and surgical planning. The purpose of this essay is to illustrate the imaging findings of these conditions.