This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Gestational Trophoblastic Disease, Subject name: Gynaecology & Obstetrics
Possible cause of choriocarcinoma after hydatidiform mole is all except: 
Select and explain. 
A. Rising hCG, B. More Theca lutein cysts, C. Increase uterus size, D. Sub urethral nodule
B: More Theca lutein cysts
Answer: B: More Theca lutein cysts 
Explanation: Ans. is b, i.e. More theca lutein cystsSuburethral Nodule indicates metastases choriocarcinoma. All others are very well seen in the conversion of a complete hydatidiform mole into choriocarcinoma except more theca lutein cyst.It is not the number of cyst but size of cyst (>= 6 cms) which indicate neoplastic \conversion.Suburethral nodule may be a manifestation of vaginal metastasis from choriocarcinoma.Metastatic choriocarcinoma is however seen in only about 4% of patients after evacuation of a complete mole and vaginal metastasis that may present with suburethral nodule occur in only 30% of patients with such metastatic disease. Hence it is an unusual indicator.Raised b-hCG level present in choriocarcinoma.