Question

In a case of vesicular mole, all of the following are high risk factors for the development of choriocarcinoma except:

• A. Serum HCG levels > 1,00,000 IU/ml
• B. Uterus size larger than 16 weeks
• C. Features of thyrotoxicosis
• D. Presence of bilateral theca lutein cysts of ovary

Hint:

Recall Hammond's criteria for high risk mole: hCG, uterine size, theca lutein cysts, age. Thyrotoxicosis is a complication, not a defining marker.

Answer 1

The Correct Option is C

This question asks which finding is NOT one of the accepted high risk markers used to flag a molar pregnancy for closer follow up after evacuation, since high risk moles carry a greater chance of turning into a persistent trophoblastic tumour or choriocarcinoma.

1. Serum HCG levels > 1,00,000 IU/ml: A very high hCG level before evacuation points to a large trophoblastic mass and is one of the classic risk markers (Hammond's criteria) used to pick out high risk moles.
2. Uterus size larger than 16 weeks: A uterus that has grown well beyond the expected size for dates means heavier trophoblastic tissue, again one of the standard risk markers for later malignant change.
3. Features of thyrotoxicosis: Very high hCG can cross react with the TSH receptor and cause mild hyperthyroid features. This is a complication seen more often in high hCG moles, but it is not one of the core markers (hCG level, uterine size, theca lutein cysts, age over 40) doctors use to grade a mole as high risk. This is the exception the question is asking for.
4. Presence of bilateral theca lutein cysts of ovary: Cysts larger than 6 cm, especially on both sides, form because of ovarian over-stimulation by the high hCG and are one of the accepted high risk markers.

Note: the original 2002 answer key left this question unanswered (marked with a question mark), so there was no official key to check against. The choice above follows Hammond's criteria, the most widely used framework, where thyrotoxicosis is a complication of a high risk mole rather than one of the defining risk markers itself.

Let's summarize:

• High risk markers for post molar malignant change: hCG > 1,00,000 IU/ml, uterus much larger than dates, theca lutein cysts > 6 cm, and age over 40.
• Thyrotoxicosis is a hormone driven complication of a very high hCG, not one of the defining risk markers.

So the exception is option (3), features of thyrotoxicosis.