A 54-year-old female presented with a two year history of progressive headaches and upper neck pain. The headaches were worse with coughing and bending. Neurological examination was unremarkable including a normal cranial nerve examination. There was no papilloedema. A computed tomogram (CT) demonstrated a midline, posterior fossa, partly fatty, partly solid mass ( Figure 1). Magnetic resonance imaging (MRI) demonstrated a mixed fatty, solid mass arising from the fourth ventricle and extending downward below the foramen magnum to the C1 level ( Figure 2). The solid portions demonstrated enhancement. In addition, in the lateral right cerebellar hemisphere, there was a second, separate, solid, enhancing mass without any connection to the larger central lesion. A subtotal resection of the tumor was achieved through a suboccipital craniectomy.The tumor had a biphasic pathologic appearance, comprised of mature adipose tissue and densely cellular neurocytic neoplasm. In some areas, these two morphologies were juxtaposed ( Figure 3A) and in other areas they were