Gynaecological pathology: gestational trophoblastic disease: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Gynaecological pathology: gestational trophoblastic disease

Sample item

Four months after a molar pregnancy was evacuated, a 26-year-old woman has haemoptysis and rising serum beta-hCG. Chest radiograph shows multiple cannonball opacities. Curettage shows sheets of atypical cytotrophoblast and syncytiotrophoblast with haemorrhage and no chorionic villi. What is the best diagnosis and treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Choriocarcinoma, treated with chemotherapy such as methotrexate or actinomycin D

Choriocarcinoma is a malignant trophoblastic tumour with two cell types and no villi, spreading early through the blood to lung. It is highly chemosensitive, and methotrexate or combination regimens give very high cure rates. An invasive mole retains villi.

Option by option

  • A. Persistent partial mole, treated with observation

    Rising hCG with metastases requires treatment, not observation.

  • B. Placental site trophoblastic tumour, treated with radiotherapy

    Placental site tumour is composed of intermediate trophoblast and is relatively chemoresistant.

  • C. Choriocarcinoma, treated with chemotherapy such as methotrexate or actinomycin D (correct)

    Correct. Absent villi with biphasic trophoblast and lung metastases indicate choriocarcinoma.

  • D. Invasive mole, treated with hysterectomy alone

    An invasive mole retains chorionic villi, so this diagnosis is excluded.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, Choriocarcinoma, treated with chemotherapy such as methotrexate or actinomycin D. Choriocarcinoma is a malignant trophoblastic tumour with two cell types and no villi, spreading early through the blood to lung.

Why is "Persistent partial mole, treated with observation" not the answer?

Rising hCG with metastases requires treatment, not observation.

Why is "Placental site trophoblastic tumour, treated with radiotherapy" not the answer?

Placental site tumour is composed of intermediate trophoblast and is relatively chemoresistant.

Why is "Invasive mole, treated with hysterectomy alone" not the answer?

An invasive mole retains chorionic villi, so this diagnosis is excluded.

What concept does this question test?

It tests Gynaecological pathology: gestational trophoblastic disease in Pathology. It is highly chemosensitive, and methotrexate or combination regimens give very high cure rates. An invasive mole retains villi.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gynaecological pathology: gestational trophoblastic disease?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.