This web site is conducted by Kennichi Kakudo, MD, PhD, professor emeritus of Wakayama Medical University and visiting professor of Kindai University, Faculty of Medicine, Japan. I am also a visiting professor of Shandon University and Taishan Medical University, China. It is designed for a personal communication with you to discuss one of the followings; 1) (to pathologists) about pathology and its future directions and case consultation, 2) (to patients) about your diagnosis and advises for your decision making, as a second opinion consultation and 3) (to physicians in the other fields), as consultation and quality control for your patients’pathology reports.
Although the most parts of this home page are written in Japanese, you may enjoy my English pages and my scientific publications written in English. Please send your comments and discussion to me at E-mail:

Second Opinion Consultation on Thyroid Diseases from Patients.
It is a well-known fact that there are severe observer disagreements in benign and malignant diagnosis of thyroid tumors (Hirokawa M, et al.: Observer variation of encapsulated follicular lesions of the thyroid gland. Am J Surg Pathol, 26:1508-1514, 2002 & Lloyd RV, et al.: Observer Variation in the Diagnosis of Follicular Variant of Papillary Thyroid Carcinoma. Am J Surg Pathol, 28(10):1336-1340, 2004). Although an accurate diagnosis is essential to ensure the most effective treatments, over-diagnoses and over-treatments are serious problems in some areas including thyroid tumors (Esserman LJ et al: Addressing overdiagnosis and overtreatment in cancer: a prescription for change. Lancet Oncol, 15:234-242, 2014.). Second opinion consultation will solve some of the problems and lead you to most proper treatments with confidence.

How to get a second opinion from Dr Kakudo.
Ask your doctor to obtain a second opinion from Dr Kakudo showing this HP ( ), and then your physician or hospital send me your histological slides and a case summary to the following address. As no official request form prepared in this HP, please includes followings in your request letter; 1) contact address, E-mail address and names where my second opinion diagnosis should be sent, 2) patient name, date of birth, and PDFs (copies) of pathology reports (first opinion) together with histological slides, 3) a case summary including clinical diagnosis and medical history of the patient, 4) questions and points where you (patient) most concern and 5) address the histological samples should be returned.
(Gross photos of resected specimens and image files such as ultrasound, CT or MRI are desirable but not must.)
Address where samples and request should be sent.
K. Kakudo, MD, PhD
Nishitomigaoka 3-11-2,
Nara-city, Nara, 631-0006 Japan.
Consultation Fee: $200.00(Two hundred US dollars).
Please transfer above sum to
The Bank of Tokyo-Mitsubishi UFJ, Ltd, Japan (bank code: 0005).
Account holder: Kakudo Kenichi
Account number: 5054926 and branch number: 458 (Kintetsu-Gakuenmae branch).
After confirmation of receipt, the samples will be returned to the address you indicated.

International Thyroid Cancer Symposium was held at the IRCAD in Taiwan on October 4, 2015.

Please find the following link for my presentation, and my title is “Classification of the thyroid follicular cell tumors – identification of borderline lesions-”.
Things usually move very slowly but sometimes the change may occur dramatically. Pathology is a very old science and usually stable and immutable, however we are facing to an epoch making drastic change in diagnosis of thyroid tumors. This is my history of diagnostic criteria for encapsulated follicular variant papillary carcinoma. The pathology diagnosis is no longer a gold standard for cancer diagnosis in thyroid tumors. You will find it in my lecture.

The 55th Annual Meeting of the Japan Thyroid Association

Centennial of Hashimoto Disease International Symposium I ”Future Perspective of Thyroid Autoimmunity”

2012.12.1 ACROS Fukuoka B2F Event Hall

[Session 5]

Yuji Nagayama (Nagasaki University Graduate School of Biomedical Sciences, Japan)
Wilmar M.Wiersinga (University of Amsterdam, The Netherlands)

3)IgG4 Thyroiditis and Fibrotic Variant of Hashimoto’s Disease
Kenich Kakudo, Yaqion Li
(Department of Medical Technology, Kobe Tokiwa University, Japan
Department of Human Pathology, Wakayama Medical University, Japan)


Recent Posts

Borderline Thyroid Tumors in WHO Classification of Endocrine Organs


4th edition WHO Classification

4th edition WHO Classification

The 4th edition of WHO Classification Tumors of Endocrine Organs was published in July, 2017. Borderline tumors of follicular cell origin were incotporated in this thyroid tumor classification very first time. I hope the introduction of the borderline tumor category in thyroid tumor classification will open a new era where pathologists have 3 choices for their diagnoses: benign, borderline, or malignant. Pathologists are no longer forced to decide between benign and malignant—it can be a borderline or precursor tumor. I believe this causes significant changes not only in pathology practice, but also brings significant impacts on clinical management of patients. It opens a new era for endocrinologists and endocrine surgeons to have 3 treatment options for patients with thyroid nodules, treat, not treat, or close follow-up (active surveillance), which would be different from the current clinical management with 2 choices (treat or not treat).  

Borderline/Precursor Tumours in the 4th Edition, 2017 WHO Classification of Thyroid Tumours.


Hyalinizing Trabecular Tumour


Other encapsulated follicular patterned thyroid tumours


Uncertain malignant potential (UMP)

2A-1-1:Follicular tumour of Uncertain malignant potential (FT-UMP)

2A-1-2:Well differentiated tumour of Uncertain malignant potential (WDT-UMP)


Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)

category: To Clinician , To pathologist , To Patient comment: (0)

NIFTP Special Issue in JBCM.


I have published a special issue on NIFTP (non-invasive encapsulated follicular neoplasm with papillary-like nuclear features) in the Journal of Basic and Clinical Medicine ( This is a very first special issue focussing on NIFTP in any scientific journals, and which covered both histological and cytological aspects. It is also characterized by international authors from 8 countries, Eastern and Western practice. This approach elucidated significal differences between the two practice. Please enjoy find those differences and underlining different way of thinking and logics.

category: To Clinician , To pathologist , To Patient comment: (0)

Working Group of Asian Thyroid FNA Cytology



18th AOTA

On March 16th. a symposium conducted by Working Group of Asian Thyroid FNA Cytology was held in Busan, Korea conjointed with the 18th International Congress of Asia Oceania Thyroid Association.  Please refere to a wechat by Dr Liu at There were 11 presentations by 10 cytopathologists from 6 (Korea, Taiwan, China, Thailand, Turkey and Japan) countries, which elucidate differences between Asian and Western practice and unsolved issues in the newly introduced tumor entity, NIFTP. Particularlly on observer valiation among reviewers on papillary thyroid carcinoma type nuclear features was reported by Dr Liu and low rates of NIFTP in Asian practice was reported by Andrey Bychkov.

category: To Clinician , To pathologist comment: (0)