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Aim: The purpose of this study is to evaluate the prevalence of the immunohistochemical subtypes of breast cancer among Lao women by using immunohistochemistry (according to the St. Gallen 2017 guidelines) and to study their correlation to clinicopathological features in order to help guide better treatment plans for patients. Materials and methods: Formalin-fixed and paraffin embedded tissue blocks of 76 cases of primary invasive breast cancer were retrieved from the University of Health Sciences, Vientiane, Lao PDR, from 2013 to 2016. Patients’ information and previous histological reports were reviewed. Immunohistochemistry was done using antibodies against estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2/neu) and Ki-67 (MIB-1). Results: The mean age of the patients was 49 years, and the major histologic type was invasive ductal carcinoma, NOS (90.7%). The proportion of each subtype was hormone receptor-positive and HER2-negative, 44.7%; hormone receptor-positive and HER2-positive, 3.9%; hormone receptor-negative and HER2-positive, 13.2%; and triple-negative, 38.2%. ER was positive in 40.8% of the cases, while PR was positive in 47.4%. More than half of the cases were poorly differentiated cancer (65.8%), followed by moderately differentiated (34.2%). Tumors presented with pT2 (60.5%), followed by pT3 (25.0%) and pT4 (7.9%). Conclusion: Breast cancer among Lao women is characterized by a large percentage of the triple-negative subtype that is less susceptible to hormonal treatments. The empirical treatment with tamoxifen should be reconsidered since it would be less effective to these patients. More importantly, basic pathology services should be the first requirement in Lao PDR in order to provide adequate care.

Background: Pathology and laboratory medicine (PALM) services are limited in low-resource countries, such as Lao PDR. Patients with malignant pleural effusion (MPE) are not properly diagnosed and treated in these situations. The purpose of this study is to confirm the usefulness of immunocytochemistry in MPE to identify the histological type and probable primary site of cancer of MPE and to discuss its usefulness in low-resource countries, such as Laos. Methods: We retrospectively reviewed glass slides of pleural effusion sent to the Department of Pathology at the University of Health Sciences from the central hospitals for cytological screening from January 2012 to December 2016. The cytological review, cell transfer and immunocytochemical staining were performed at Tokyo Medical and Dental University. Among 81 cases of MPE from Laos, 66 cases of malignant tumors that contained enough tumor cells were included in this study, and the slides were screened with 14 primary antibodies to classify the histological type and identify the probable primary site of carcinoma. Results: Among the 66 cases, 34 cases (52%) were of female patients, and 32 cases (48%) were of male patients. The patients’ ages ranged from 28 to 88 years with an average of 58 years. The immunocytochemical study identified 32 cases (49%) of primary lung adenocarcinoma, two cases (3%) of malignant mesothelioma, one case (1.5%) of breast/gynecological carcinoma, one case (1.5%) of T cell lymphoma, and one case (1.5%) of B cell lymphoma. Twenty-nine cases (43.5%) were classified as carcinoma not otherwise specified. Pulmonary small cell carcinoma/squamous cell carcinoma and metastatic colon, prostate, and liver carcinoma were not identified among the cases. Conclusions: Immunocytochemistry is a useful ancillary method in MPE diagnostics. This method could be applied in the pathological laboratories in low- or middle-resource countries, such as Laos.

Background: Most developing countries have been unable to implement well-organized health care systems, especially comprehensive Pap smear screening-based programs. One of the reasons for this is regional differences in medical services, and a low-cost portable cervical screening system is necessary. To improve regional discrepancies in cervical screening systems, we investigated the usefulness and acceptability of cervical selfsampling by liquid-based cytology (LBC) for 290 volunteers in the Lao PDR. Materials and Methods: Following health education with comprehensive documents, cervical self-sampling kits by LBC were distributed in three provincial, district, and village areas to a total of 290 volunteers, who were asked to take cytology samples by themselves. Subsequently, the acceptability of self-sampling was evaluated using a questionnaire. Results: The documents were well understood in all three regions. Regarding the acceptability of self-sampling, the selections for subsequent screening were 62% self-sampling, 36% gynecologist-sampling, 1% either method, and 1% other methods. The acceptability rates were higher in the district and the village than in the province. For the relationship between acceptability and pregnancy, the self-sampling selection rate was higher in the pregnancy-experienced group (75%) than in the pregnancy-inexperienced group (60%). For the relationship between selection of self-sampling and experience of screening, the self-sampling selection rate was higher in the screening-inexperienced group (62%) than in the screening-experienced group (52%). Conclusions: Our data show that this new way forward, involving a combination of self-sampling and LBC, is highly acceptable regardless of age, educational background, and residence in rural areas in a developing country.

Background Lao PDR is the least developed country in East Asia and medical conditions are poor. The pathological examination has been performed only in Vientiane Capital, and there are only nine pathologists in the whole country. We performed a campaign tour for Pap-test promotion in the North Eastern provinces in Lao PDR in 2012. The NPO Japan Support Group for Lao Pathology and NCGM supported the project. Details Four pathologists and two technologists visited two provincial and two county hospitals in a van to hold a cytological workshop for medical staff and to perform Pap smear tests for healthy female volunteers. A total of 839 females participated in the Pap smear tests, among whom cytological abnormalities were detected in 60 participants (7%) including 11 HSIL, 9 ASC-H, and 40 LSIL. Conclusion As no cancer registration has been initiated in Laos except for the trial of LUHS in Vientiane, the prevalence of cervical cancer is unknown. This result suggested a high prevalence of cervical cancer and hence that of high-risk human papilloma viral infection in the North Eastern provinces. This type of campaign tour seems effective to promote Pap smear test among both medical staff and local residents in the rural areas.

The aim of this study was to evaluate the diagnostic value of rapid cytological examinations at autopsy. Rapid cytological diagnosis was performed for nine cases at autopsy using Papanicolaou and/or Giemsa staining. Material was obtained by imprint or needle-aspiration. Among 9 cases, 5 cases were sarcoma, 3 cases carcinoma and 1 case infectious disease. All cases were reported to the physicians during autopsies. Precise medical informations including rapid cytological examination were informed immediately to bereaved family members. The present study showed that rapid cytological examination in conjunction with autopsy is an easy procedure and is not only useful in the concrete diagnosis of death by unknown causes but also helpful in deciding appropriate management of materials for the next steps such as electron microscope diagnosis.