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Peritoneal metastases from high-grade serous carcinoma of ovary have to be distinguished from malignant mesothelioma and primary papillary serous carcinoma of the peritoneum. Histologic features favoring mesothelioma include prominent tubulo-papillary pattern, abundant eosinophilic cytoplasm, uniform cells lacking significant cytologic atypia, and increased mitotic activity. The distinction of peritoneal papillary serous carcinoma from its ovarian counterpart is much more challenging as their histologic, immunohistochemical, and ultrastructural features are identical.