In a case of vesicular mole all of following are high risk factors for the development of choriocarcinoma except:: (A) Serum hCG levels >100000 mIU/mL, (B) Uterus size larger than 16 week, (C) Features of thyrotoxicosis, (D) Presence of bilateral theca lutein cysts of ovary
Answer is C. Ans. is c, i.e. Features of thyrotoxicosisRef. William 24/e, p 401Risk factors for malignant changeComplete mole (15-20% case)Patient's age >=40Serum hCG >=100,000mIU/mLUterine size >= large for gestational ageTheca lutein cysts: large (>6cm diameter)Slow decline in b-hCGSonographic appearance of myometrial nodules or hypervascularity postevacuation is also a predictor of subsequent neoplasia.From the above list it is clear that option "a" is correct.Coming on to option "d" i.e. Presence of bilateral theca lutein cyst Williams Obs. 23/e, p 259"Montz and colleagues (1988) reported that gestational trophoblastic neoplasia was more likely in women with theca-lutein cysts, especially if bilateral." (i.e. option "d" is correct).So that leaves us with 2 options 'b' and 'c'. As far as uterine size larger than 16 weeks is concerned-According to Dutta p 197 - Size of uterus >20 weeks is considered as a risk factor and not > 16 weeks, but according to other books excessive uterine enlargement is one of the risk factor- no specific size has been mentioned.As far as thyrotoxicosis is concerned I did not get any literature regarding, it being one of the risk factors.So, option 'c' is the answer of choice.