Scar endometriosis is a rare, extra pelvic endometriosis which occurs following uterine surgeries and can be a diagnostic challenge due to its varied clinical presentations. Clinically, it can mimic conditions such as abscess, suture granuloma, desmoid tumor, and even metastatic malignancy. As it usually presents as a swelling near the scar site, fine needle aspiration and cytology often becomes the first diagnostic test that the clinicians ask for and it plays a significant role in providing the right diagnosis and guide for management. We report one such case, of a 35 year old female who presented with a swelling in the left lower abdomen, with a clinical diagnosis of lipoma where fine needle aspiration and cytology helped to clinch the diagnosis of scar endometriosis.