<p>Cervical tuberculosis (TB) is a rare form of extrapulmonary tuberculosis that can mimic cervical malignancies due to overlapping clinical and radiological features. This report presents a 55-year-old woman with postmenopausal vaginal discharge, foul odor, and a suspected neoplastic cervical mass, initially raising concerns for cervical cancer. Ultrasound and pelvic MRI showed cervical thickening with heterogeneous echoes and possible pelvic lymph node involvement, suggesting malignancy. Colposcopy revealed cauliflower-like lesions on the cervix, with friable tissue and positive contact bleeding. Despite a negative HPV test and normal serum SCC antigen levels, biopsy revealed granulomatous tissue with caseous necrosis, leading to a diagnosis of cervical tuberculosis, confirmed by a positive interferon-gamma release assay (IGRA). Further chest CT identified multiple pulmonary nodules. The patient was successfully treated with standard anti-tuberculosis therapy, consisting of isoniazid, rifampin, ethambutol, and pyrazinamide. This case highlights the diagnostic challenges of cervical tuberculosis, which can closely resemble cervical cancer, and underscores the importance of considering tuberculosis in the differential diagnosis, particularly in TB-endemic areas. Early diagnosis and appropriate treatment are crucial for preventing complications and improving patient outcomes.</p>