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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