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We report a case involving the concomitant presentation of two rare conditions: heterotopic adrenal tissue in the pelvic peritoneum and serous surface papillary carcinoma. A postmenopausal woman with an abdominal cystic mass and generalized ascites underwent laparotomy with the suspicion of ovarian carcinoma. Final histopathological analyses revealed serous surface carcinoma with metastasis to the endocervical canal, bilateral fallopian tubes, omentum, and para-aortic lymph nodes. Heterotopic adrenal tissue was also detected in the peritoneum. Serous surface carcinoma of the peritoneum should be considered in the differential diagnosis when ascites, omental caking, and peritoneal nodules are observed in a patient with or without an ovarian mass. Heterotopic adrenal tissue is another rare condition in adults and can be detected incidentally in the peritoneum.