Background: The rare epithelial ovarian cancer subtype known as Low-Grade Serous Carcinoma (LGSC) of the ovary has different clinical characteristics and a unique molecular profile. Compared to high-grade serous carcinoma, this tumor develops early, advances more slowly, and is associated with a longer survival period. Primary surgical cytoreduction to no discernible residual disease is a key prognostic factor. It is characterized by a very high level of chemotherapeutic resistance. Case Presentation: An 18-year-old nulligravida lady, presented with right flank pain of 4 days duration that worsened a day before her presentation. On examination, she had stable vital signs, mild tenderness in the right lower quadrant of the abdomen, but no guarding or rigidity. With an initial assessment of bilateral ovarian tumor + query perforated appendicitis assisted by imaging study; emergency laparotomy was done and biopsy was taken from both ovarian masses, and omentum and diagnosed as Low-grade serous carcinoma of both ovaries with secondary omental deposit. After she took four cycles of neoadjuvant chemotherapy, a relaparotomy was done to do surgical staging/ cytoreductive surgery, and she is currently on follow up. Conclusion: A rare histological subtype of epithelial ovarian cancer, Low-Grade Serous Carcinoma (LGSC) of the ovary, accounts for just 2%-5% of serous carcinomas. Even though the median age upon diagnosis is 46.9 years old, adolescents are still rarely affected. The mainstay of treatment is surgery, and as this cancer is not particularly sensitive to chemotherapy, it is strongly advised to perform a primary maximal cytoreduction.
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