Epithelial Inclusion Research Articles

Subconjunctival epithelial inclusion cyst complicating strabismus surgery: Early excision is better

Epithelial inclusion cysts can occur following otherwise-uncomplicated strabismus surgery. Because of their tendency to grow posteriorly into the orbit, they should be monitored closely or treated when relatively small. We report and discuss an illustrative case.

Intracranial cholesteatoma – case report and critical review

Chronic otitis media is a potentially serious disease because of its complications, most of which are common in conjunction with cholesteatomas. There is variance in the terminology used by neurosurgeons, otorhinolaryngologists and neuropathologists. Synonyms for cholesteatoma found in the literature include epidermoid tumor, epidermoid cysts and epithelial inclusion cyst. Intracranial extension of an acquired cholesteatoma is a rarely documented occurrence. A 47-year-old woman who had undergone a right tympanomastoidectomy 20 years previously, presented with a long history of mild headaches that had become progressively more severe over the last 3 years. Clinical and radiological evaluation of the patient raised the suspicion of an intracranial cholesteatoma. A right temporal craniotomy was performed. The mass was completely excised and histopathological study revealed the tumor to be a cholesteatoma. The patient's post-operative recovery was uneventful. Cholesteatomas possess the capacity for eroding bone and can have an insidious onset, but once established, grows relentlessly and destroys neighboring structures. Since a gradual intracranial involvement does not usually cause acute symptoms of increased intracranial pressure, the correct diagnosis may be difficult. Detailed clinical and radiographic studies in particular are diagnostically helpful. Because of the high incidence of delayed recurrence, life-long follow-up is required. The inconsistency in the histopathological classification of intracranial cholesteatomas should be clarified.

Heterotopic breast tissue versus occult metastatic carcinoma in lymph node, a diagnostic dilemma

Breast cancer is the leading cause of cancer in women and the third leading cause of cancer mortality in the United States. We report a case of a patient who underwent bilateral simple mastectomies and right sentinel node biopsy for invasive lobular carcinoma in the right breast. An ipsilateral sentinel lymph node showed a microscopic focus of ductal elements. Although residual lobular carcinoma was identified in the right breast, no ductal carcinoma was identified in either breast. The ducts were discrete distributed in a 3-mm focus in the lymph node parenchyma as well as the subcapsular sinus. By immunohistochemistry, the ducts were positive for cytokeratin, estrogen receptor/progesterone receptor and did not show a myoepithelial layer by P63 or smooth-muscle myosin heavy-chain staining. The differential diagnosis includes heterotopic epithelial inclusions and benign mechanical transport. Mechanical transport of the breast tissue was ruled out because primary tumor type in the breast and the ductal structures in the lymph nodes were of different types. The diagnosis of occult metastatic tumor was based on the lack of the myoepithelial layers associated with the ductal structures. The diagnostic dilemma of the differential diagnoses is discussed, and pertinent literature is reviewed.

PAX2 expression in low malignant potential ovarian tumors and low-grade ovarian serous carcinomas

Ovarian tumors of low malignant potential and low-grade ovarian serous carcinomas are thought to represent different stages on a tumorigenic continuum and to develop along pathways distinct from high-grade ovarian serous carcinoma. We performed gene expression profiling on three normal human ovarian surface epithelia samples, and 10 low-grade and 10 high-grade ovarian serous carcinomas. Analysis of gene expression profiles of these samples has identified 80 genes upregulated and 232 genes downregulated in low-grade ovarian serous carcinomas. PAX2 was found to be one of the most upregulated genes in low-grade ovarian serous carcinoma. The upregulation of PAX2 was validated by real-time quantitative RT-PCR, western blot and immunohistochemical analyses. Real-time RT-PCR showed a statistically significant difference in PAX2 mRNA expression (expressed as fold change in comparison to normal human ovarian surface epithelia) among ovarian tumors of low malignant potential (1837.38, N=8), low-grade (183.12, N=17), and high-grade (3.72, N=23) carcinoma samples (P=0.015). Western blot analysis revealed strong PAX2 expression in ovarian tumors of low malignant potential (67%, N=3) and low-grade carcinoma samples (50%, N=10) but no PAX2 protein expression in high-grade carcinomas (0%, N=10). Using immunohistochemistry, tumors of low malignant potential (59%, N=17) and low-grade carcinoma (63%, N=16) samples expressed significantly stronger nuclear staining than high-grade ovarian carcinoma samples (9.1%, N=263). Furthermore, consistent with earlier immunohistochemical findings, PAX2 expression was expressed in the epithelial cells of fallopian tubes but not in normal ovarian surface epithelial cells. Our findings further support the two-tiered hypothesis that tumors of low malignant potential and low-grade ovarian serous carcinoma are on a continuum and are distinct from high-grade ovarian carcinomas. In addition, the absence of PAX2 expression in normal ovarian epithelia but expression in fallopian tube fimbria and ciliated epithelial inclusions would suggest the potential development of tumors of low malignant potential and of low-grade ovarian serous carcinomas from secondary Müllerian structures.

Gundersen Flaps in the Management of Ocular Surface Disease in an Asian Population

To evaluate the indications, complications, and long-term outcomes with the use of a Gundersen flap for the treatment of various ocular surface conditions in an Asian population. Retrospective case series. Twenty-five eyes of 25 subjects who had undergone conjunctival flap surgery performed from 1999 to 2004 at the Singapore National Eye Centre. Review of case records for indications and outcomes of patients undergoing Gundersen flap surgery. Surgical success was defined as attainment of a stable ocular surface with resolution of symptoms and no flap retraction or dehiscence resulting in reexposure of the corneal surface. Complications to be noted included infection, progression of the inflammatory or infectious disease process beneath the flap, flap loss from epithelial ingrowth, and epithelial cyst formation. Surgical success was achieved in all eyes. Intraoperative and postoperative complications were encountered in 6 patients (24%). One case had a buttonhole, 3 cases had partial flap retractions, and 2 had epithelial inclusion cysts. The Gundersen flap is still an important procedure and should be considered as a means of stabilizing globe integrity in the management of cases of severe ocular surface disease, particularly when visual potential is poor.

A case of multiple unilateral corneal epithelial inclusion cysts in a dog

A three-year-old neutered female Labrador cross was presented for investigation of two corneal epithelial inclusion cysts affecting the left eye. The aetiopathogenesis of the cyst formation was suspected to be traumatic. The cysts were removed successfully by superficial keratectomy, followed by a third eyelid flap. Histologically, both lesions were represented by cystic formations lined with multi-layered squamous epithelium, consistent with stromal inclusion of surface corneal epithelium. Complete recovery was achieved, and there was no recurrence at six month follow-up.

Inflammatory Cytokine Tumor Necrosis Factor α Confers Precancerous Phenotype in an Organoid Model of Normal Human Ovarian Surface Epithelial Cells

In this study, we established an in vitro organoid model of normal human ovarian surface epithelial (HOSE) cells. The spheroids of these normal HOSE cells resembled epithelial inclusion cysts in human ovarian cortex, which are the cells of origin of ovarian epithelial tumor. Because there are strong correlations between chronic inflammation and the incidence of ovarian cancer, we used the organoid model to test whether protumor inflammatory cytokine tumor necrosis factor alpha would induce malignant phenotype in normal HOSE cells. Prolonged treatment of tumor necrosis factor alpha induced phenotypic changes of the HOSE spheroids, which exhibited the characteristics of precancerous lesions of ovarian epithelial tumors, including reinitiation of cell proliferation, structural disorganization, epithelial stratification, loss of epithelial polarity, degradation of basement membrane, cell invasion, and overexpression of ovarian cancer markers. The result of this study provides not only an evidence supporting the link between chronic inflammation and ovarian cancer formation but also a relevant and novel in vitro model for studying of early events of ovarian cancer.

Discoid lupus erythematosus presenting with cysts, comedones, and cicatricial alopecia on the scalp

To the Editor: Discoid lupus erythematosus (DLE) of the scalp usually starts with red-purple macules, papules, or small plaques that then develop into erythematous hairless patches. In early lesions, ostia may still be present, and in the course of the disease, hair follicles are irreversibly destroyed and the lesions become atrophic.1Olsen E.A. Bergfeld W.F. Cotsarelis G. Price V.H. Shapiro J. Sinclair R. et al.Summary of North American Hair Research Society (NAHRS)-sponsored Workshop on Cicatricial Alopecia, Duke University Medical Center, February 10 and 11, 2001.J Am Acad Dermatol. 2003; 48: 103-110Abstract Full Text Full Text PDF PubMed Scopus (291) Google Scholar, 2Whiting D.A. Cicatricial alopecia: clinico-pathological findings and treatment.Clin Dermatol. 2001; 19: 211-215Abstract Full Text Full Text PDF PubMed Scopus (150) Google Scholar, 3Headington J.T. Cicatricial alopecia.Dermatol Clin. 1996; 14: 773-782Abstract Full Text Full Text PDF PubMed Scopus (98) Google Scholar A 33-year-old female patient of East Indian descent was referred to the University of British Columbia hair clinic with a complaint of patchy hair loss. The patient had developed DLE lesions on the lateral aspect of the upper nose, cheeks, and on her left ear, and small areas of hair loss on the scalp 1 and a half years before her visit at our clinic. Her previous dermatologist treated her with hydroxychloroquine 200 mg twice daily, intralesional triamcinolone acetate 5 mg/cc on five occasions, and topical betamethasone dipropionate 0.05% lotion twice daily for 1 year and strongly emphasized sun protection. Over the past year, her facial lesion had considerably improved. However, her scalp lesions progressed in spite of the treatment. On her first visit, the patient showed several skin colored plaques and nodules on her scalp, displaying cicatricial alopecia. Four lesions presented with cribriform openings, releasing yellow-brown horn-like material similar to fistulated comedones (Fig 1). The scalp biopsy showed classic pathologic features of the DLE and epidermal inclusion cysts (Fig 2).Fig 2A, A 2-mm punch biopsy showing a deep lymphocytic, perivascular infiltrate and an interface dermatitis in the follicular epithelium. B, Prominent interface dermatitis. (Original magnification: A, ×40; B, ×100.)View Large Image Figure ViewerDownload Hi-res image Download (PPT) We continued oral treatment with hydroxychloroquine and treated the lesions topically with tretinoin 0.025% cream (Retisol-A 0.025% cream; Stiefel Canada Inc, Montréal, Quebec, Canada) for 2 and a half months. The scalp lesions did not improve, and we decided to discontinue both hydroxychloroquine and topical tretinoin. Oral isotretinoin was suggested as a treatment option, but the patient refused. Four weeks later, the patient developed a new DLE lesion on her face and three new firm subcutaneous nodules without associated comedones on her scalp. Moreover, two of the scalp lesions showed a marked progression in size and an increase of comedone-like openings within the lesions. We treated the remaining lesions with intralesional triamcinolone acetate injections 10 mg/cc every 6 weeks and clobetasol 0.05% lotion twice daily and restarted oral treatment with hydroxychloroquine. On subsequent visits, we added mechanical extraction of the comedones to our treatment plan. Under this combination therapy, the lesions flattened and stabilized. We decided to refer the patient for an excisional biopsy of one large stable lesion on her vertex area. The lesion measured 2 cm in diameter and was reconstructed with a bilateral rotation flap. The histologic findings showed benign epithelial inclusion cysts and comedones with surrounding scarring; however, there were no features of active lupus erythematosus. Excision of the remaining cystic lesion was refused by the patient. DLE has been described with acneiform lesions and comedones.4Chang Y.H. Wang S.H. Chi C.C. Discoid lupus erythematosus presenting as acneiform pitting scars.Int J Dermatol. 2006; 45: 944-945Crossref PubMed Scopus (13) Google Scholar, 5Deruelle-Khazaal R. Ségard M. Cottencin-Charrière A.C. Carotte-Lefebvre I. Thomas P. Chronic lupus erythematosus presenting as acneiform lesions.Ann Dermatol Venereol. 2002; 129 ([French]): 883-885PubMed Google Scholar, 6El Sayed F. Dhaybi R. Ammoury A. Bazex J. Lupus comedonicus (in French).Ann Dermatol Venereol. 2007; 134: 897-898Crossref PubMed Scopus (5) Google Scholar, 7Pramatarov K.D. Chronic cutaneous lupus erythematosus—clinical spectrum.Clin Dermatol. 2004; 22: 113-120Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar Whether the nodules and comedones in our case are primary or a secondary change is not clear. The site of our first punch biopsy, which was taken 1 and a half years after the patient developed her first lesions, showed comedone-like structures and histologically cysts and features of DLE. These findings suggest that the cysts and comedones are part of the primary DLE lesion. The excised lesion on the vertex area showed no histopathologic features of DLE but still showed epidermal inclusion cysts. This can be possibly regarded as the secondary change of the scarring process.

Myocardial Adenomatoid Tumor in Eight Cattle: Evidence for Mesothelial Origin of Bovine Myocardial Epithelial Inclusions

The adenomatoid tumor is an uncommon benign lesion, thus far described only in humans. Adenomatoid tumors typically arise in the genital tract, exceptionally in the heart, and usually represent an incidental finding. Microscopically, they are constituted by epithelioid cells that form tubular structures and anastomosing channels within a fibrous stroma. Mesothelial origin of these lesions is suggested by their immunohistochemical characteristics. In cattle, previously reported myocardial epithelial inclusions are morphologically similar in that the cells are immunoreactive for both cytokeratins and vimentin, and bear surface microvilli. Myocardial lesions found incidentally at slaughter in 8 cattle histologically resembled the so-called bovine myocardial epithelial inclusions and had morphologic and immunohistochemical features consistent with human adenomatoid tumor. All lesions were in the left ventricular myocardium, adjacent to the epicardium, and composed of epithelioid cells that formed cords and tubules, and were immunoreactive for pan-cytokeratins, cytokeratin 5/6, vimentin, calretinin, Wilms' tumor 1 suppressor gene, and CD30 antigen. By electron microscopy, numerous long slender microvilli were associated with desmosomes and tonofibrils. The immunohistochemical and ultrastructural features were considered consistent with mesothelial origin. These lesions, corresponding to the previously described myocardial epithelial inclusions in cattle, might be considered embryologic rests and could represent the bovine counterpart of the human adenomatoid tumor.

Epithelial Inclusion Cyst Associated With a Porous Polyethylene Orbital Floor Implant

A 50-year-old man presented with reduced vision, hyperglobus, and an inferior orbital mass 3(1/2) years after the repair of an orbital floor fracture using a porous polyethylene (Medpor) implant. On funduscopy, the sclera was markedly indented. This was associated with retinal striae and a retinal pigment epithelial disturbance involving the macula. CT revealed a large inferior orbital cystic mass displacing the globe. The cyst was excised and the orbital implant was removed. Histologic findings were consistent with a respiratory epithelial inclusion cyst. Postoperatively, the vision improved and the hyperglobus resolved. The retinal striae and pigmentary disturbance persisted. Late capsule-related complications, such as epithelial cyst formation and intracapsular hemorrhage, have been reported in association with nonporous materials only. This case demonstrates that epithelial cyst formation may occur in association with a porous orbital floor implant and result in visual impairment.

Reincident corneal epithelial inclusion cyst in a dog: a case report

An unilateral corneal epithelial inclusion cyst (CEIC) in a 8-years-old female mixed Poodle is reported. The cyst had been observed for 60 days, was unique, not congenital and only one eye was involved. One year prior to the referral the dog was treated with antibiotics due to an ocular trauma caused by a fight with a cat. In the same eye, palpebral melanocytic tumor and corneal dystrophy were also observed. In order to remove the CEIC a superficial keratectomy was performed. Collagen contact lens and topical antibiotics were the medical treatment of choice. Fifteen month after surgery the dog was referred for recurrence of the CEIC. A second keratectomy and similar topical treatment was attempted again. A second recurrence 16 months after surgery has not been observed to the date. Cytology and histology analysis of the cyst confirmed the diagnosis of the CEIC. Microbiologic studies were also realized and <i>Staphylococcus epidermidis</i> was aisled twice in fifteen months. In this case a relapsing CEIC is reported associated to <i>S. epidermidis</i> contamination. Corneal dystrophy and palpebral melanoma were concomitant lesions, although no relations with the CEIC were concluded.

Overexpression of follicle-stimulating hormone receptor facilitates the development of ovarian epithelial cancer

We previously showed that the expressing level of FSH receptor (FSHR) increased from ovarian epithelial inclusions (OEIs) to benign ovarian epithelial tumors (OETs) and to borderline OETs, whereas FSHR levels decreased with an increase in carcinoma grade. The aim of this study was to investigate the role of FSHR in OET development. MCV152 cells with FSHR overexpression showed an increased cellular proliferation and invasive capacity, which was associated with reduced levels of prohibitin and RII-β expression and increased levels of HER-2/neu, c-Myc, and EGFR expression. Overexpression of FSHR may be associated with an elevated level of OET cell proliferation via an enhanced activity of potential oncogenic pathways. Therefore, the findings in this study suggest that overexpression of FSHR may play a role in OET development.

Epithelial inclusion cyst arising in an intramammary lymph node: Case report with cytologic findings

The occurrence of epithelial inclusion cysts (EIC) in axillary lymph nodes is a rare but well recognized entity, arising either from direct implantation or from embryonal rests. Theoretically, EIC can occur in intramammary lymph nodes, but there has been only one prior report of such a lesion. Here, we describe a case of an EIC arising in an intramammary lymph node of a 37-year-old woman. This report focuses on the FNA cytologic features of this lesion and its differential diagnoses. On FNA, the EIC arising in an intramammary lymph node was characterized by mature lymphocytes, squamous epithelial cells, and keratinizing material. The presence of squamous cells can lead to the erroneous diagnosis of more common breast lesions, such as squamous cell carcinoma or metaplastic carcinoma. Contrary to these more sinister diagnoses, EIC arising in an intramammary lymph node is a benign condition. As this rare lesion sometimes mimics a neoplasm both clinically and radiographically, awareness of this entity is important to prevent over treatment.

Bona Fide Primary Merkel Cell Carcinoma of an Intraparotid Lymph Node in a HIV-Positive Patient

Merkel cell carcinomas are uncommon malignant tumors thought to originate from the neuroendocrine cells of the skin that mainly affects sun-exposed body areas, particularly the head and neck. In approximately 10% of cases, they present with localized lymphadenopathy without any clinical evidence or history of a primary lesion, but a truly primary lymph node Merkel cell carcinoma may occur, possibly originating from epithelial inclusions or an anomalous neuroendocrine differentiation of hematopoietic stem cells. It has been observed that Merkel cell carcinoma is more likely to affect patients whose immune status is impaired as a result of iatrogenic immunosuppression, human immunodeficiency virus infection, or hematological malignancies. This study reports the case of a bona fide primary Merkel cell carcinoma arising in an intraparotid lymph node of a patient infected by HIV that had a particularly unfavorable clinical course.

Three‐dimensional ultrasonographic characteristics of endometriomata

Endometriosis is a common condition, affecting somewhere between 5% and 60% of women of reproductive age and approximately 2 million women in the UK. The exact prevalence is difficult to ascertain and varies according to diagnostic criteria used and the populations studied, varying from 2 to 50% in women without symptoms, 40 to 60% in women with dysmenorrhea, and 20 to 30% in women with subfertility1,2. The etiology is unknown, but the disease is characterized by the objective demonstration of endometrial-like tissue outside the uterus. The condition is seen predominantly in women of reproductive age, and it occurs in all ethnic and social groups. Whilst extrapelvic disease can occur, endometriosis typically affects the pelvic organs and peritoneum. Disease severity is assessed semi-quantitatively at laparoscopy or laparotomy and is scored according to the American Society for Reproductive Medicine3, but is a poor predictor of the patient’s symptoms in many cases. The extent of the disease varies considerably; it may involve small areas of the peritoneum alone, or be associated with significant fibrosis, adhesions and nodular infiltration, in different individuals with the same symptoms1. The ovary may be involved only superficially or can contain a cyst lined with endometrial-like tissue known as an ‘endometrioma’. Endometriotic cysts have always been a controversial entity. There is no consensus as to the pathological processes which define their development or to their management in terms of the timing, type and effects of surgery. Opinion is divided as to whether these cysts arise from progressive invagination of endometriotic deposits on the ovarian cortex4,5, from metaplasia of epithelial inclusions in the ovary5,6 or because of secondary involvement of functional ovarian cysts in the endometriotic process7. The invagination theory is accepted by most, but there is no agreement as to whether the endometrial cells are superficial ovarian implants of endometriosis or they are derived through metaplastic transformation of normal ovarian cortical tissue. The invagination theory is supported by histological studies, which consistently show that these cysts are pseudocysts, with no real plane of cleavage between the endometrialtype stroma and the ovarian cortex, containing an obliterated, mostly endometrial-gland, lining8. The walls of an endometrioma are initially thin, but subsequently become fibrotic and thickened, and can give the cyst an irregular external border. Endometriomata are typically small, with 81% measuring between 30 and 59 mm in diameter9, although they can reach 15–20 cm in diameter. Is an isolated endometrioma a different disease from peritoneal endometriosis? Many women are found to have an endometrioma without evidence of peritoneal disease, and the pathophysiological mechanisms that determine how the disease is expressed remain unclear. Women with peritoneal endometriosis are thought to have reduced fertility, and surgical treatment may improve fecundity in those with minimal to mild disease10. Just how endometriosis affects fertility is unknown, but any effect probably relates to anatomical distortion and immobilization of the pelvic organs through adhesion formation and organ infiltration and/or a change in the peritoneal environment to one that is less favorable for fertilization and embryo implantation. The effect of an isolated endometrioma on fertility is less clear, and there is no definitive evidence that fertility is impaired. However, surgical intervention is often recommended when an endometrioma measures more than 3–4 cm in diameter11 and so, unsurprisingly, endometriomata represent the most frequently reported histological subtype following operative laparoscopy for the excision of ovarian cysts12. Preoperative detection of endometriomata is therefore important, and ultrasound is the investigative tool of choice in most cases. Conventional two-dimensional ultrasound has an established role in the detection of adnexal masses and in their differentiation through pattern recognition of characteristic morphological patterns13. Most studies use transvaginal rather than transabdominal ultrasound, as this approach allows a closer approximation of the probe to the ovary and the use of higher frequencies, which provide better resolution. However, transvaginal

Traumatic Epithelial Inclusion Cyst of the Anterior Corneal Stroma

To report a case of posttraumatic epithelial inclusion cyst of the anterior corneal stroma. Case report. A 17-year-old girl presented with a large painless mass of the right cornea. After simple surgical excision, histopathologic examination confirmed the diagnosis. There was no recurrence during a 2-year period of follow-up. Traumatic epithelial inclusion cysts can be easily managed with simple surgical excision.

Corneal epithelial inclusion cyst in a Llama

A 13-year-old, female Llama presented for evaluation of a limbal based corneal mass involving the OD of 4 months duration. The mass was excised en bloc by a nonpenetrating keratectomy, followed by placement of a conjunctival advancement flap covering the keratectomy site. The mass was submitted for histological evaluation. Histopathology identified the mass to be a corneal epithelial inclusion cyst filled with necrotic squamous and neutrophilic debris. Surgical excision was complete and considered curative with no signs of recurrence 3 months postoperatively. There was no known prior ocular trauma; however, a previously performed corneal biopsy for evaluation of recurrent epithelial erosions may have been an initiating cause.

High frequency of gastroduodenal cytomegalovirus infection in liver transplant patients

The prevalence and significance of cytomegalovirus (CMV) detected in biopsy specimens from the gastroduodenal mucosa of liver transplant patients, patients with chronic or acute liver failure and immunocompetent patients with dyspeptic symptoms were evaluated. 80 liver transplant patients with upper gastrointestinal symptoms, 132 patients with chronic and 25 with acute liver failure, and 33 immunocompetent, dyspeptic patients underwent oesophagogastroduodenoscopies, with biopsies from the duodenum and stomach. CMV was demonstrated by immunohistochemistry in frozen sections, using a monoclonal antibody against CMV-specific antigens (pp65 matrix protein), and in paraffin sections by a monoclonal antibody against delayed early protein (p52). 71% of the liver transplant patients, 45% of the patients with chronic liver disease, 20% with acute liver failure, and 45% of the immunocompetent, dyspeptic patients had CMV-positive findings in the gastroduodenal mucosa (liver transplant patients vs other groups, p<0.01). Histopathological findings in CMV-positive samples were focal inflammation, including increased inflammation of the lamina propria, infiltrating leukocytes intra-epithelially, regenerative changes in the epithelial cells and inclusion bodies. In conclusion, CMV-positive cells and inclusions are often found in the gastroduodenal mucosa of liver transplant patients, as well as in patients suffering from chronic liver disease or even in otherwise healthy patients with dyspeptic symptoms.

Human postmenopausal ovary--hormonally inactive fibrous connective tissue or more?

The ovary undergoes several changes after the menopause. In this period, the main structural changes in both the cortex and medulla were observed. In the cortex, they included: 1) reduction of its thickness; 2) epithelial inclusions forming cysts; 3) blurring the line between medulla and cortex; 4) reduction of follicles number; 5) tendency to fragmentation of corpora albicantia; 6) surface epithelium invaginations. Whereas the changes in the medulla included: 1) fibrosis and scars in stroma; 2) architectonical changes in blood vessels with hyalinization of walls and constriction of lumen. The loss of follicles and several changes in the ovary are due to apoptotic processes. Despite age related atrophic changes, the postmenopausal ovary is not devoid of hormonal activity. Our results are coherent with the reports of other researchers, and reveal that postmenopausal ovary produces trace quantities of steroid hormones, mainly androgens, and confirm the presence of steroid receptors and activity of main enzymes involved in steroidogenesis process.

Renal benign epithelial nodal inclusions

There are 3 case series reports describing benign epithelial inclusions in nodal sinuses of perinephric lymph nodes of pediatric patients. The majority of these inclusions were observed in perinephric lymph nodes removed during nephrectomies from pediatric patients with Wilms' tumors. We report 2 cases of benign renal tubular epithelial inclusions located in the perinephric hilar lymph nodes. One of our cases is, to our knowledge, the first case of benign renal epithelial inclusions reported in an adult patient.