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Introduction. Adnexal masses represent a diagnostic dilemma judging from the imaging and serum markers point of view. Making a correct diagnosis is of utmost importance as ovarian cancer represents a real health issue in the entire world nowadays with diagnosis in more advanced stages with low survival rates. Case presentation. Herein we present the case of a 44-year-old patient who arrived at the emergency ward for asthenia, loss of appetite, weight loss and severe dyspnea. When making the clinical examination a nontender distended abdomen was discovered with a large rather irregular mass in the left iliac fossa. An emergency computed tomography and ultrasound was solicited rendering a high suspicion of malignancy. Further analyses rendered an elevated carcinogenic antigen125 marker with high adnex model risk of malignancy and high risk of malignancy assessment score. A scheduled laparotomy was undertaken in a mixed team of gynecology and oncology surgeons discovering an intense pelvic inflammatory disease with good recovery. Conclusions. Ovarian masses represent a diagnostic dilemma as neither the imagistic evaluation nor serum markers represent absolute accuracy. A high degree of suspicion is thus imperative and whenever necessary when scheduling laparotomy a specialized oncology surgeon has to complete the surgical team.