A 39 year-old married woman Gravida 6, para 6 has been transferred to the gynecologic ward from the gasteroentrology ward with the complain of abdominal pain, weight loss and fever in the last 4 months (Figure 2). Her past medical history was unremarkable, and in her surgical history, last 2 deliveries were through cesarean section and she performed the tubal ligation. It is worth to mention that her normal menstrual pattern has been changed to oligomenorrhea since last 6 months. She had also a positive family history; her mother had been diagnosed with pulmonary TB. 
Her abdominopelvic examination revealed a fixed and tender mass in the pelvis. As Case 1, due to positive family history for TB, a chest X-ray and skin tuberculin test has been performed and both were negative for TB.
Profiling of serum tumor markers and revealed a high level of CA-125: 207 u/mL. ESR: 27. Hemoglobin was 10 mg%.
Pelvic ultrasonography disclosed uterus and adnexa as a large complex cystic mass shifting to the right with extensive adhesion to the adjacent structures. As the preoperation assessment was in favour of ovarian malignancy, the patient underwent exploratory laparatomy with a midline incision. There was no ascites, but miliary seeding all over the peritoneum and small bowel and large bowel, uterus, fallopian tubes and ovaries were seen, which were biopsied. A confluent mass containing uterus, ovaries and fallopian tube was seen which was necrotic. The frozen sections of the biopsied specimens showed granulation tissue, but as the family was completed and the mass was necrotic, hysterectomy and bilateral salpingo oophorectomy have been done. Peritoneal cavity was washed with normal saline and closed. The permanent result of pathology showed many granulomatous lesion comprised epithelial cells, histiocytes, giant cells. Right ovary and right tube were unremarkable, left ovary, fallopian tube and uterus had granulomatous lesion consistent with tuberculosis. Patient discharged with anti tuberculosis drugs.