Diverticulosis of the appendix is a relatively rare pathological finding. The majority are acquired pseudodiverticula. True congenital diverticula are very rare. Appendiceal diverticulosis is usually an incidental finding and clinically asymptomatic. When symptomatic, it is usually complicated by acute or chronic diverticulitis with or without acute appendicitis. It presents with atypical abdominal signs and symptoms, mostly in adult males. Appendiceal diverticulitis is a distinct entity with several clinical and pathological differences from acute appendicitis. It has a more rapid progression to perforation and a higher rate of mortality. Therefore, appendiceal diverticulitis should be considered in the clinical differential diagnosis, especially in adult males with chronic abdominal pain. Appendiceal diverticulosis demonstrates a significant association with obstructing or incidental appendiceal neoplasms. It may play an important role in the development of pseudomyxoma peritonei, which is associated with appendiceal mucinous tumors. Therefore, meticulous gross examination and thorough histological examination of the entire appendicectomy specimen are essential. When discovered either by preoperative radiological investigations or during an exploratory operation, prophylactic appendicectomy is advocated to prevent the risk of complications and to rule out the possibility of a coexisting neoplasm.

Granulomatous appendicitis is a rare phenomenon. Idiopathic (primary) granulomatous appendicitis is very rare. It is a diagnosis by exclusion. There are many etiologies, both infectious and noninfectious, for secondary granulomatous appendicitis. Isolated appendiceal Crohn's disease (CD) is no longer an accepted explanation of idiopathic granulomatous appendicitis, but rather, it is thought to be part of more generalized gastrointestinal CD. Yersinia infection and CD constitute the main etiology of granulomatous appendicitis in the West. Infectious causes, mainly tuberculosis and parasitic infestations, are the main culprits in tropical and subtropical countries. This variation is probably a result of differences in the geographical distribution of these diseases. Recently, interval appendectomy has been suggested as an important cause of granulomatous appendicitis. The importance of interval appendectomy may vary according to the local practice of this procedure in each region. Other unusual causes may include sarcoidosis and foreign body reaction, mainly as a result of vegetable matter from feces. A review study of 3381 appendectomy specimens over a 4-year period showed only 13 cases (0.38%) of granulomatous appendicitis. Infectious and noninfectious causes were responsible for 62% and 38% of granulomatous appendicitis, respectively. Parasites alone were responsible for 38.5% of the cases. Interval appendectomy and CD each contributed 15% and 8%, respectively, of the total etiology. Granulomatous appendicitis was more common in young adult males.

Routine microscopic examination of all LSG specimens is not necessary. Selective microscopic examination guided by relevant clinical history and macroscopic examination is a better option. This protocol will save money, time, and workload without compromising patient's safety and future management. However, a careful gross description is still necessary in certain cases for potential future medicolegal implications.

Cytomegalovirus (CMV) infection in immunocompromised patients is a common opportunistic systemic infection which can lead to death, and usually presents with visceral manifestations, especially of the lung, brain, eye, and gastrointestinal tract. Cutaneous CMV infection is, however, relatively rare in immunocompromised patients. Cutaneous CMV infection can have variable clinical and histologic manifestations, and thus can be easily missed. We report a case of cutaneous CMV infection in a patient with acquired immunodeficiency syndrome, presenting as a generalized, pruritic, erythematous, maculopapular eruption.

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One of the merits of ThinPrep 1 (TP) liquid-based preparation in cervical cytology is the reduction of the unsatisfactory rate in comparison with conventional smears. 1-3 This is achieved by reducing the presence of obscuring hemorrhage, inflammation, lubricant, mucus and nonblood contaminant materials in the background, and by virtue of the rapid fixation that allows clear viewing of the cellular details. 1-3 However, certain technical problems, probably inherent within the TP technique, can lead to unexpected limitations with regards the final satisfactory rate, especially when handling bloody material from symptomatic women. 3 Hemorrhagic smears can lead to deceptively unsatisfactory material that on occasions can hide significant epithelial abnormalities. Attempts to overcome this drawback can be a beneficial and a relatively cost-effective measure. Reprocessing by glacial acetic acid (GAA) wash is one way to improve the satisfactory rate of TP Pap tests.We conducted a prospective study over a 2-year period to investigate the effectiveness of reprocessing of unsatisfactory TP Pap slides in improving the overall satisfactory rate. We also studied the ability of reprocessing to uncover significant epithelial abnormalities. We used the 2001 Bethesda System, which requires a minimum number of squamous cells of 5,000 for liquid-based cytology to be clearly visualized. 4 Therefore, TP Pap tests slides with squamous cells less than 5,000 cells or poorly visualized and obscured cells were considered unsatisfactory and they were reprocessed. The remaining, residual Pre-servCyt 1 vial contents were transferred into a centrifuge tube. The fluid was centrifuged at 3,000 rotations per minute for 5 minutes. The supernatant was decanted, leaving a pellet at the bottom. A volume of 27 ml of CytoLyt 1 solution and 3 ml of concentrated GAA were added to the tube, and the contents were resuspended by vigorous agitation and recentrifuged at 3,000 RPM for 5 minutes. A 5 ml of PreservCyt 1 solution was added to the pellet, homogenized, and then added to a new PreservCyt solution TP vial and the solution was homogenized by vigorous manual agitation. A new second TP Pap slide was prepared using ThinPrep 2000 machine with a new filter. The reprocessing took 45 minutes and together with 30 minutes for Pap stain, the total turnaround time was 75 minutes.The study covered 8,224 TP Pap tests. Of these, 336 (4.08%) cases showed unsatisfactory Pap tests. After reprocessing, 285 (84.8%) cases showed satisfactory second slides, while 51 (15.2%) cases remained unsatisfactory. The final unsatisfactory Pap tests were reduced to 51 (0.62%) with a reduction rate of 69.6% of the unsatisfactory Pap tests. Of the 285 postprocessing satisfactory cases, 31 (10.9%) cases showed additional significant epithelial abnormalities. Of these, 15 (58.06%) cases showed atypical squamous cells of undetermined significance (ASCUS), 5 (16.13%) showed low-grade squamous intraepithelial lesion (LSIL), 4 (12.9%) showed high-grade squamous intraepithelial lesion (HSIL...

Intramammary lymph nodes (IntraMLNs) are frequent mostly benign incidental findings. However, they are clinically important because they can be the primary sites of metastasis and sentinel lymph nodes. Literature data regarding the clinical significance of IntraMLNs metastasis, however, remains controversial. This study aimed to perform a systematic review and meta-analysis to better define the prognostic value of positive IntraMLNs in patients with breast cancer. A systematic review of the literature without date restrictions was conducted. Five electronic medical databases were searched, and a hand-search of the reference lists of the collected articles was also performed. Studies with sufficient and relevant pathologic and clinical survival data were included. Other studies with insufficient data or normal findings were excluded. This study found 18 studies eligible for systematic review, 3 of which were eligible for outcome meta-analysis. IntraMLNs metastases were strongly correlated with axillary lymph nodes involvement. Positive IntraMLNs are reliable predictors of axillary lymph node involvement and therefore a guide for further surgical management of the axillary nodes. Even though it could be concluded that IntraMLNs metastasis is an independent predictor of outcome, this meta-analysis was limited because of the scarcity of data and the inconsistencies and heterogeneity of the outcome studies.

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