Malakoplakia is a rare inflammatory disease usually found as an ulcer on urogenital tract, but it can involve any other part of the body. Because of its versatility of presentations, diagnosis is achieved with high suspicion. The final diagnosis is confirmed with specific pathology called Michaelis-Gutmann bodies. We present pelvic malakoplakia mimicking endometrial cancer in imaging studies. A 52-year-old woman had been diagnosed with SLE 19 years ago and had been taking oral corticosteroid since then. Because of intermittent LLQ pain from 2017, she was diagnosed with bilateral TOA and received laparoscopic BSO in 2018. The pathology report showed chronic active inflammation with foamy cell collection. However, persisting pelvic pain led her to take CT and MRI in April 2019 and the images revealed 7cm irregular mass in left adnexa and infiltrative lesion in uterus suggesting endometrial cancer. She underwent D&C and the pathology presented the same as before. She visited the ER in 2019 with septic condition. She received acute shock care.After recovery, we planned a debulking surgery. During the surgery, severe pelvic adhesion and multiple hard, catheter-shaped foreign bodies were observed in left parametrium, left pararectal space, and left internal iliac artery. Caseous necrotic materials were spread deep into the left pelvic and paravaginal space. TAH and debulking operation of the left pelvic mass including left pelvic lymph nodes were performed. The pathology was foamy histiocytes aggregation, acute and chronic inflammation with Michaelis-Gutmann bodies, consistent with malakoplakia. As recommended treatment, we continued Tazoperan. After the antibiotic sensitivity test done with E.coli from peritoneal fluid, we changed the antibiotic to Ceftazidime. Because the postop CT taken on POD #9 showed a recurred 9cm mass in left pelvis, we escalated to Tazoperan. On POD #21, she was referred to general hospital for further conservative care with antibiotic.