Fig. 9
Malignant struma arising from the left ovary in a 40-year-old woman presenting with abdominal distension and lower abdominal pain. CA-125 levels were elevated at 1,075 kU/l (normal value <12 kU/l). a Ultrasound shows a mixed solid cystic mass with predominantly solid features. On the 3-T T2-weighted high-resolution (b), unenhanced (c) and enhanced (d, f) T1 fat-saturated LAVA and diffusion-weighted images b = 1,200 mm/s2 (e), imaging features resemble a mucinous cystadenocarcinoma. d, e The lacy pattern caused by the enhancing solid elements (representing thyroid tissue) can be seen on T1 post-contrast imaging (d) and diffusion imaging (e) might be the only feature to suggest a struma. d, f Ascites is present (A) as well as extracapsular extension which is seen as tumour nodules on the capsular surface (arrow). d, e Some contrast medium uptake is shown in the tissues between the ovary and pelvic sidewall on the right (arrow). b, d, e A simple cyst arising from the right ovary does not present with restricted diffusion (arrowheads)