The detection of immunoreactivity by confocal microscopy is a reliable method to evaluate colocalization; moreover, immunofluorescence also prevents changes in the labeling of epithelial cells in relation to the exposure time, as could be observed in techniques based on enzymatic reactions.
In our study, not all ovarian samples were positive for ER alpha, AR, and GPR30 in epithelial cells from the surface epithelium or the cortical inclusion cysts. The immunoreactivity for ER alpha is the least frequent in ovary samples, only a quarter of the ovaries were positive. The presence of AR and GPR30 was observed in about the half of the ovaries, 0.42 and 0.69, respectively. Previous studies have shown the expression of the mRNA for ER alpha, AR, and PR in four primary cultures of surface epithelial cells obtained from ovaries of postmenopausal women . Moreover, the expression of AR, PR, and ER alpha has also been described in cells of the surface epithelium and epithelial inclusion cysts of ovaries of postmenopausal women; the expression of AR and PR remain unchanged, but intensity for ER alpha decreases in relation to years after menopause . Our results do not detect changes in the frequency of positive reaction for ER alpha, AR, and GPR30 in the ovary of premenopausal and postmenopausal women; this discrepancy could be explained because the present study evaluates proportion of positive reaction observed in the ovary, without discriminating the intensity of reactions.
The expression of the hormone receptors is detected in epithelial cells of the ovarian surface and epithelial inclusion cysts; however, in about 20% of ovaries, the positive reaction does not coincide in both locations. This finding suggests that cortical inclusion cysts could be a heterogeneous structure, as it has been proposed in relation to the metaplasic changes detected in the epithelium of inclusion cysts . However, changes caused by the tissue processing techniques could not be totally discarded.
The increase in the proportion of AR positive immunoreactivity in epithelial cells of the ovary in women with cervical squamous carcinoma is an unexpected finding. It seems to be specific because the proportion of ER alpha and GPR30 is similar in patients with cervical carcinoma compared with other proliferative pathologies.
The presence of androgen receptor in the epithelial cells of the ovary could represent the constitutive expression of this receptor in female reproductive tissues. Then, the increase in the frequency of AR that we observed in epithelial cells of the ovary would be associated to changes in androgen receptor expression in cervix. A previous study indicates that androgen receptor expression changes in invasive squamous cell carcinoma of the cervix compared with normal cervical epithelium . Moreover, AR regulates the expression of key factors involved in cell proliferation and invasion, as cyclin D1, TGFbeta1 and E-cadherin . Therefore, extensive studies will be required to corroborate the relationship of cervical carcinoma with androgen receptor expression.
Alternatively, human papillomavirus (HPV) infection could simultaneously affect cervix and other reproductive organs. There is evidence of the presence of HPV (types 16, 18, 31, 33, 53) in the human ovary  and HPV transcripts were detected in uterine endometrioid carcinoma . Changes in the expression of androgen receptor in the ovary would be related to HPV infection. Similar to previous findings in cervix describing a high estrogen receptor expression related with HPV infection; this observation is not dependant on a particular HPV type . Future studies will address the relationship of HPV infection with AR expression in epithelial cells of the ovary.