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case_images: Abdominal ultrasound indicating a mixed echogenic mass in the right enlarged ovary without clear boundary. The dotted line surrounds blood flow signals detected in the interior and surrounding tissue.
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case_images: An abdominal ultrasound scan indicated a 6.9 x 6.0 cm cystic-solid mass in the right ovary (Figure 1), and abdominal computed tomography showed a 7.1 x 5.6 x7.5 cm heterogeneous dense mass, in the right annex, containing multiple irregular high-density calcification shadows and low-density areas in the interior.
case_images: (a-c) Papillary structures are visible, with ground-glass nuclei, nuclear groove, and overlapping nuclei, including pseudo-inclusion bodies; (d-f) Malignant area of struma ovarii. Cellular nuclei show atypia and the tumor has infiltrated into ovarian tissues, which form hyperplastic follicles similar to follicular thyroid cancer, without nuclear grooves, nuclear pseudo-inclusion bodies or nuclear overlap and ground glass nuclei.
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case_images: Postoperative histological examination showed a tumor, with atypical and ground glass cellular nuclei, lacking nuclear grooves, nuclear pseudo-inclusion bodies or overlap, and infiltrating into ovarian tissue, forming hyperplastic follicles similar to those found in follicular thyroid cancer (Figure 2).
case_images: Specific nuclear positivity for TTF-1 in thyroid follicles.
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case_images: Immunohistochemistry analysis demonstrated positivity for TTF1 (Figure 3), Ag, pan-CK, CK7, PAX8 and 5% Ki67, but negativity for CR, ER, WT1, MelanA, inhibin and SALL4.