Practicing Subspecialty Histopathology in a Developing Country: Is it Feasible?

1 The practice of histopathology is still in the early evolutionary phase in many developing countries including Pakistan. As depicted vividly by Zubair et al. a vast preponderance of lesions which should be biopsied are actually never biopsied in this part of the world, and even many surgical specimens removed from the patient are not subjected to histopathological evaluation. Worse even, if the biopsy material is sent to the laboratories, its complete histopathological evaluation is not done due to the non-availability of ancillary techniques, like immunohistochemistry (IHC), molecular techniques, and electron microscopy (EM) in the majority of laboratories. Only a few centers in Pakistan, mostly in the private sector, are doing meaningful histopathology practice. In rest of the laboratories, the majority of which are in public sector institutions, the diagnosis is still rendered on simple haematoxylin and eosin (H&E) stained slides. Even special tinctorial stains, like Masson's trichrome and silver based stains are not available in these laboratories, or if available, the quality is suboptimal. The concept and the practice of subspecialties in histopathology in Pakistan are also at primitive stage, to say the least, as in most other developing countries. Even the few centers of repute claiming to practice quality histopathology lack this luxury, which is the routine in developed countries. Obviously, then the conditions will be