Primary fallopian tube carcinoma (PFTC) is the rarest gynecologic malignancy. We present the first documented case of this rare neoplasm in Ethiopia, in a 50 years old perimenopausal woman. The patient complained of irregular menses, on and off vaginal discharge and longstanding lower abdominal pain. She had longstanding infertility for which she did not seek medical help. The patient was subjected for laparotomy with the preoperative diagnosis of chronic pelvic inflammatory disease. Huge bilateral hydrosalpinges were found with pelvic adhesions involving the ovaries. Total hysterectomy with bilateral adnexectomy was performed following adhesiolysis. The diagnosis of low-grade papillary tubal carcinoma was made postoperatively when the specimen from total abdominal hysterectomy and bilateral salpingoopherectomy was examined histologically. The patient declined relaparatomy for proper staging or further adjuvant treatment. She was free of clinically demonstrable recurrence five months after discharge. Challenges in the detection of PFTC relating to its signs and symptoms, diagnostic difficulties, choice of treatment and factors that may influence survival are outlined It is prudent to perform histopathologic examination on all surgically excised specimens however obvious the clinical findings appear to be.