Background: We present the case of one patient with early ovarian cancer complicated with lymphatic tuberculosis (TB) and discuss the significance of lymph node resection for ovarian cancer. We also reflect on the limitations of the preoperative imaging evaluation of lymph node metastasis and suggest possible solutions. The clinical data of a patient with early ovarian cancer complicated with lymphatic TB were analyzed retrospectively.Case Description: A 37-year-old woman was diagnosed with a left ovarian malignant tumor and multiple pelvic and abdominal lymph node metastases using full abdominal computed tomography (CT) and 18-fluorodeoxyglucose-positron emission tomography/computed tomography ( 18 FDG-PET/CT) before surgery. Intraoperative frozen pathology findings suggested an adult-type granulosa cell tumor (AGCT).Transabdominal debulking surgery and lymph node dissection were performed. Routine pathological results suggested that the tumor was confined to the left ovary and the lesion in the pelvis and abdomen was lymph node TB. The Federation International of Gynecology and Obstetrics (FIGO) pathological stage was IA1, so lymph node dissection was unnecessary. After discharge, the patient received anti-TB drugs. She recovered without bleeding, lymphatic cyst, lymphedema, or other surgery-related complications.Conclusions: Clinicians should, therefore, avoid relying exclusively on imaging results. Instead, it is necessary to make comprehensive decisions based on a combination of the patients' medical history, intraoperative condition, and histopathological type. If necessary, clinicians should sample suspicious and/or increased lymph nodes and send them for intraoperative frozen pathological examination. Excessive surgical treatment and early misdiagnosis in ovarian cancer should be avoided.

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