Purpose or Case Report:

Childhood acute lymphoblastic leukemia (ALL) is the most common childhood malignancy, accounting for 25% of pediatric cancers. Relapse occurs in 15–20% of cases, and only 2–6% has extramedullary localization, with the central nervous system being the main site. Relapse of ALL in gynecological organs is extremely rare and it manifests with profuse vaginal bleeding or nonspecific symptoms such as abdominal pain.
Methods & Materials:

A 12-year-old patient, with history of IR ALL at 6 years and subsequent late relapse. The patient visited ER, after 6 months of finalization of her treatment, for hypogastrium pain of 12 hours of evolution. She reported profuse bleeding during the last cycle.
Results:

An abdominal and gynecological ultrasound was performed, which revealed a solid, hypoechoic mass with slight vascularization affecting the lateral and anterior walls of the uterus, measuring 5.9 x 5 x 4.9 cm, and another mass with similar characteristics affecting the left ovary, measuring 2.5 x 2.3 cm. Laboratory findings revealed leukocytosis and high LDH levels, and PAMO with 50% blasts.
High Resolution Magnetic Resonance Imaging of the pelvis(MRI) shows an enlarged uterus due to diffuse myometrial infiltration without clear boundaries, along the body and fundus on its posterior, anterior and left lateral surfaces. The endometrium, cervix, tubes and ovaries are preserved. The lesion enhances poorly and late after the contrast administration, with visible tortuous mural vessels. A lymph node cluster in the left hypogastrium measuring 24 x 28 mm.
Signs of bone marrow inhomogeneity in relation to underlying disease.
Based on this findings, the patient has a combined second relapse (bone marrow and uterine). Treatment with corticosteroids and chemotherapy is being initiated.
Conclusions:
With the advent of new chemotherapy regimens and drugs, survival has improved significantly, and while the relapse rate has decreased, it has not been completely eliminated.
The evaluation of gynecological organs during the ultrasounds studies is vitally because, although extramedullary involvement in this localization is rare, it can represent the first finding of disease relapse, as in our patient's case.
Early detection allows for timely intervention and a better prognosis.