Introduction: Appendiceal neoplasms comprise a low percentage of gastrointestinal malignancies. These malignancies are most often noted incidentally on imaging or during surgery. There are few case reports describing malignancy of the appendix during pregnancy and even fewer that involve abnormal pregnancies, such as molar or ectopic pregnancy.Case Report: This is the case of a 32-year-old female who presented with an unknown last menstrual period (LMP), positive home pregnancy test, and right adnexal mass. Due to the concern for ectopic pregnancy, she underwent laparoscopic assessment, revealing an appendiceal neoplasm. She was subsequently diagnosed with a concurrent molar pregnancy. Conclusion:Given the proximity of the appendix to right-sided adnexal structures, appendiceal tumors can be mistaken for ovarian masses, or vice versa. Appendiceal adenocarcinoma often presents with symptoms of acute appendicitis and can mimic the pain of a ruptured ectopic pregnancy in reproductive aged women. Therefore, it is important for clinicians to consider involvement of both structures while evaluating an adnexal mass. Ultrasound imaging is the standard of care for women presenting with pelvic pain and an elevated b-hCG; however, alternative imaging modalities should be considered when ultrasound findings are not definitive.