In a case of vesicular mole all of following are high risk factors for the development of choriocarcinoma except :
Ans. is c i.e. Features of thyrotoxicosis "Risk of developing choriocarcinoma following hydatiform mole ranges between 2-10%." Risk factors for malignant changes in case of H.mole : Patient above the age of 40 irrespective of parity. Patient having previous 3 or more bih irrespective of age (age is more impoant than parity). Initial HCG level in urine of over 100,0011.1 / 24hours. Uterine size > 20 weeks. Previous history of molar pregnancy. Large (>6cms) theca lutein cysts. From the above list it is clear that option "a" is correct. Coming on to option "d" i.e. Presence of bilateral theca luteum cyst "Monti and colleagues (1988) repoed 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 factors and not 16 weeks. but according other books excessive uterine enlargement is one of the risk factor. 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.
Serum HCG levels > 100000 miu/ml
Uterus size larger than 16 week
Features of thyrotoxicosis
Presence of bilateral theca lutein cysts of ovary