B-Lymphoblastic Leukemia Presenting as Bilateral Ovarian Masses in a 20-Year-Old Woman.

Hematologic malignancies involving the ovaries are rare and may mimic ovarian carcinoma. We report a 20-year-old woman who presented with generalized body pain, bilateral ovarian masses, and abdominal adenopathy, initially suspected to have ovarian carcinoma. Despite normal blood counts, a retroperitoneal lymph node biopsy and subsequent bone marrow biopsy confirmed B-lymphoblastic leukemia. Molecular analysis identified multiple pathogenic alterations, including CREBBP, KMT2D, and KRAS mutations, CDKN2A copy number loss, and FLT3 overexpression. The patient developed tumor lysis syndrome and was transferred to a tertiary center, after which she was lost to follow-up. While long-term treatment response could not be evaluated, this case underscores the clinical necessity of including B-lymphoblastic leukemia/lymphoma in the differential diagnosis of bilateral ovarian masses in young women, even with normal peripheral blood counts. Early tissue diagnosis through minimally invasive biopsy is essential to avoid unnecessary surgery and to initiate appropriate systemic therapy.