Bone marrow aspirate and biopsy were performed which showed normal trileneage hematopoesis and immunohistochemical stains using antisera to Myeloperoxidase (arrow) confirmed the myeloid elements. Among the common causes of extramedullary hematopoesis are myelofibrosis and hemoglobinopathy. Hemoglobin electrophoresis, quantitative hemoglobin A2/F and α-thalassemia gene studies were normal and JAK 2 mutation was not detected. Final pathological diagnosis was adrenal myelolipoma, a rare benign neoplasm composed of mature fat cells admixed with hematopoeitic cells.The most widely accepted pathogenesis is the theory of metaplasia of the reticuloendothelial cells of blood capillaries in the adrenal gland .The significance of extramedullary hematopoeisis in this otherwise healthy adult is unclear at this time.