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The practice of histopathology in a developing country: difficulties and challenges; plus a discussion on the terrible disease burden we carry
  1. Z Ahmad,
  2. A Qureshi,
  3. A Khurshid
  1. Aga Khan University, Karachi, Pakistan
  1. Dr Z Ahmad, Aga Khan University, Karachi, Pakistan; zubair.ahmad{at}

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Histopathology as a science is still evolving in Pakistan. A majority of lesions which should be biopsied are actually never biopsied, and even many resection specimens are never sent for histopathological examination. For a population of 160 million people, there are only three to four centres of note where meaningful histopathology is practised. We work as consultant histopathologists at the Department of Pathology, Aga Khan University (AKU), in Karachi, Pakistan’s largest city. The Section of Histopathology at the Department of Pathology, AKU is the largest centre for histopathology in Pakistan. Other major centres for histopathology in the country include the Shaukat Khanum Memorial Cancer Hospital (SKMCH) in Lahore, and the Armed Forces Institute of Pathology (AFIP) in Rawalpindi. In addition, there are a few smaller centres in various cities which can be counted on fingers. In the vast majority of clinical laboratories across the country, histopathology facilities are very primitive and on a very small scale. There is a great dearth of qualified histopathologists, and basic tools for accurate histopathological diagnosis (especially facilities for immunohistochemistry, which is the most valuable adjunct to H&E staining in diagnostic histopathology), are not available at more than half a dozen centres. Even in the larger centres, issues of costing and expenditure have led to slashing of budgets and rising costs of histopathology, with resultant losses to the centres, and increased cost to the patients. Hence, most laboratories and pathology centres in the country are reluctant and not too keen to provide optimum histopathology facilities, which as mentioned above, are rather primitive in nature. In addition, many clinicians (both physicians and surgeons), especially those practising in smaller cities and towns across the country, are unaware (or unwilling) to accept the importance of a histopathological evaluation in the diagnosis and management of disease. In many cases, …

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