I'm not sure how things work in the pathology world, but several of my colleagues went through this "second look" business when applying for cardiology fellowship spots, and I was surprised about what they told me. For many programs, the "second look" was really more like a mandatory second interview, whereby those applicants who don't attend are viewed as not being truly interested in the program, and are thus not ranked to match. I don't know if things go this way in the pathology world, but in cardiology these types of stories are unfortunately quite common (and unfair, not to mention prohibitively expensive for many). There's a lot of pride out there about how far down the match list a program goes, hence this "second look" foolishness. But fellowship programs are quite different than most residency programs in that they're often quite a bit smaller, and thus want to be even MORE sure that they're getting people who they like, who get along well with the faculty, and are a good "fit" with the program and institution. After all, if you only have 4 spots, two bad apples can just ruin everything!
Again, not sure how much this applies to path, but I thought it might be helpful as a discussion point and as some food for thought.