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Tattoo pigment in sentinel lymph nodes in melanoma patients is a clinical challenge. A 77‐year‐old man presented with a pink nodular lesion of the right upper arm. Biopsy revealed a 1.9 mm thick, Clark level 4 nodular melanoma. A wide local excision with 2 cm margins and sentinel lymph node (SLN) mapping was planned. Pre operative lymphoscintigraphy using technetium‐99 m demonstrated a single strongly pigmented SLN in the right axilla. A prominent tattoo was located on the patient’s upper arm in the area of the melanoma. The clinical impression was highly suspicious for metastatic disease and the tissue was sent to pathology for examination. Frozen section showed a lymph node with benign histiocytes. There were black non‐polarizable coarse granules in the subcapsular, sinusoidal areas and also in the histiocytes. Review of permanent hematoxylin and eosin sections as well as immunohistochemical analysis with MART‐1 and HMB‐45 showed no evidence of metastatic melanoma in the SLN. Pigmentation of lymph nodes is not pathognomic of malignant melanoma. Black pigmented lymph nodes can occur by carbon deposits of tattoo pigment as in our case. Histological confirmation of metastatic malignant melanoma in the SLN is imperative before proceeding to complete regional lymph node dissection.

Pilonidal sinus is a well-recognized condition that occurs most commonly in the sacrococcygeal area of younger men. It is hypothesized to be an acquired chronic inflammation condition due mainly to hair trapped beneath the surface. A pilonidal sinus in the sacrococcygeal region is associated with recurrent infection, abscess formation, cellulitis, fistulae, and rarely, squamous cell carcinoma. A pilonidal sinus of the penis is a rare entity. The association of a penile pilonidal cyst and Actinomyces is even more uncommon with only three cases reported previously. Two cases of pilonidal sinus are reported in this paper. One of the cases was associated with actinomycosis. Pilonidal sinus of the penis should be considered in the clinical and pathological differential diagnosis and has to be distinguished from balanoposthitis, epidermal cyst, and carcinoma. The knowledge about possible association with actinomycosis is important to ensure early treatment.

A Ab bs st tr ra ac ct t We describe a rare variant of papillary thyroid carcinoma (PTC), the Cribriform-Morular Variant (C-MV). A handful of cases have been described in the literature of this entity. They exhibit the morphologic features of a distinctive papillary neoplasm along with solid, cribriform, and squamoid-morular areas. The cribriform and morular features make this a separate entity which could be mistaken for a high grade aggressive thyroid neoplasm. These lesions are usually associated with familial adenomatosis polyposis (FAP) but rarely may be sporadic. We report three cases that we have encountered. K Ke ey y w wo or rd ds s thyroid neoplasm, papillary thyroid carcinoma, cribriform, squamoid, morularA Au ut th ho or r b bi io og gr ra ap ph hy y Shylashree Chikkamuniyappa, MD, is a final year Anatomic/Clinical pathology resident at Univ TX Hlth Sci Ctr at San Antonio. She is serving as the Chief resident in the department and serving on various institutional and national committees. She is currently working on several research projects with faculty and presented at national meetings. She will pursue her fellowship in hematopathology for the next 2 years.

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