INTRODUCTION: Acute Lymphoblastic Leukemia (ALL) with ovarian infiltration is a rare and poorly prognostic extramedullary manifestation, especially in young women. Its clinical presentation is variable and can mimic acute abdominal pathologies, which delays diagnosis. It is estimated that up to 35% of autopsies in patients with acute leukemia reveal ovarian involvement. CASE PRESENTATION: We present the case of a 28-year-old woman with cytopenias and persistent low back pain, in whom bilateral ovarian infiltration was identified through ultrasound and biopsy, confirming ALL-B. The transvaginal ultrasound showed enlarged, hypoechoic ovaries with increased intraovarian vascularity, in addition to an anechoic unilocular cystic image in the right ovary. The diagnosis was confirmed by immunohistochemistry, and the patient responded favorably to the AHOPCA protocol. CONCLUSION: This case highlights the importance of considering ovarian infiltration in the differential diagnosis of adnexal masses and performing a multidisciplinary evaluation when suggestive findings are present.
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