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 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.