A 30-year-old woman presents with abdominal pain and light -colored, vaginal bleeding. She mentions that before that she had missed period, tender breast, and severe nausea and vomiting, and edema. Blood pressure is 140/90. Pulse is 85. The patient could not conceive a child for about 2 years. Sonography shows solid collection of echoes with numerous small (3-10 mm) anechoic spaces (granular appearance). Blood tests and urinalysis show normal lactic dehydrogenase levels, HCG of 100,000 mIU/mL, and proteinuria. Microscopically, there is diffuse villous enlargement with marked hydropic changes, cistern formations and distended core of the villus traversed by widely separated broken strands of fibrillar material, and marked cellular hyperplasia in a circumferential pattern, remarkable cytologic atypia, mitosis, stromal mucin and stromal nuclear debris. This patient is most likely to have:
A) Ovarian cyst
Β) Gestational trophoblastic disease
C) Pseudo-pregnancy
D) Ectopic pregnancy
E) Endometriosis
F) Spontaneous miscarriage
G) LH-secreting adenoma
H) Dysgerminoma
It’s B: severe nausea and vomiting (hyperemesis gravidarum)+ sonography finding (snowstorm appearance/ granular appearance)+ the microscopic findings+ toxemia (hypertension, albuminuria, and edema)