<prompt> In a case of vesicular mole all of following are high risk factors for the development of choriocarcinoma except:Serum hCG levels 100000 mIUmLUterus size larger than 16 weekFeatures of thyrotoxicosisPresence of bilateral theca lutein cysts of ovary  <response>: Ans. is c, i.e. Features of thyrotoxicosisRef. William 24e, p 401Risk factors for malignant changeComplete mole 15-20 casePatients age 40Serum hCG 100,000mIUmLUterine size large for gestational ageTheca lutein cysts: large 6cm diameterSlow 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. 23e, p 259Montz 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. 