Myelolipoma is a rare neoplasm composed of an admixture of mature adipose tissue and hematopoietic elements. It typically occurs in adrenal glands as a solitary, well-circumscribed mass, and the thoracic location is extremely unusual. We present a 63-year-old man with an accidentally detected tumor of the chest wall. Thoracoscopic resection and subsequent histopathologic examination of the lesion revealed myelolipoma with bony spicules, which are an unusual component in this neoplasm. We discuss the etiology, histopathology, differential diagnosis, and recommended management of extra-adrenal myelolipoma, and we conclude that it should be considered in the differential diagnosis of subpleural chest wall tumors.