A 24-year-old married, nulligravid woman was referred from gasteroentrology ward to the gynecologic ward with the complain of abdominal pain and distension, nausea, on and off vomiting in the preceding 3 months. Her past medical history was unremarkable but in gynecologic history hypomenorrhea was highlighted (Figure 1). Family history revealed that her father had been diagnosed with pulmory TB, also her cousin had been involved with genital TB. During physical examination, she was a pale young lady with a distended abdomen and a fixed mass palpated up to the umbilicus. 
In her paraclinic investigations, among all serum tumor markers related to ovarian cancer, there was only a mild elevation of CA-125 (45 U/mL) Hemoglobin was 9.0 mg/dL. As she had a positive family history for TB a chest X-ray and skin tuberculin test have been performed and both were negative for TB.
Pelvic ultrasonography showed a normal size uterus with endometrial thickness equal to 5 mm. There was a septated multicystic mass of 134 x 140 x 81 mm cube in right adnexa with extension toward the left adnexa. Left ovary was also bigger than normal (70 x 35) mm containing multiple follicles. The ascites in the abdominopelvic cavity with spreading behind the liver was present. Sonographic impression was mucinous cystadenoma of ovary or hydatid cyst.
Abdominopelvic computed tomography showed large amount of ascites in peritoneal cavity with cystic and solid vegetative mass, mild thickening of peritoneal layers in lower abdomen suggesting ovarian mucinous cystadenocarcinoma with peritoneal metastasis was noted. Other possibilities suggested were primary carcinoma of mesenteric, peritoneal like mesothelium, or papillary carcinoma of peritoneum.
Because of highly suggestion of ovarian malignancy preoperation, the patient underwent exploratory laparatomy with midline incision. Total volume of 400cc ascitic fluid was aspirated and sent for cytology and culture. There were severe adhesions and miliary seeding all over the abdominal and pelvic organs. Adhesions were released. Then left ovary 5 x 5 x 6 cm appeared with hemorrhagic cyst and adhesion to the left fallopian tube. So left salpingo oophorectomy was done and the specimen was sent for frozen sections. The result of frozen sections was granulomatous inflammation compatible with tuberculosis. So peritoneal cavity was washed with normal saline and closed. The result of permanent pathology was chronic granulomatous salpingitis compatible with tuberculosis. Ovary: hemorrhagic cyst of corpus luteum. Patient discharged with antituberculosis drugs.