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

The 11th Asia Pacific IAP Congress in Hefei, China


APIAP in Hefei, China

professor Osamura, Schmitt and Liu

With my Chinese daughters, Dr Bai, Dr Li and Dr Liu in Hefei.
Dr Liu, Dr Bai and Dr Li.

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Thyroid FNA Cytology, Differential Diagnoses and Pitfalls


Thyroid FNA Cytology, Differential Diagnoses and Pitfalls

Thyroid FNA Cytology, Differential Diagnoses and Pitfalls

The second edition, Thyroid FNA Cytology, Differential Diagnoses and Pitfalls, was published, both online and print edition, from Springer in May, 2019. Please visit at There are significant differences in our practice, particularlly between Asian and Western practice. As a results, quality measures (proportions of cytological categories, resecttion rates, risks of malignancy and AUS/M ratio) were significantly different among us even all usees the Bethesda system reporting thyroid FNA cytology. For the purpose of providing individualized guides to readers who are practicing in various geographic areas with different medical settings and social resources, the second edition tries to cover more than those provided by the first edition, and authors from 15 countries (Australia, Canada, China, Korea, Japan, Italy, Philippine, Portugal, Switzerland, Taiwan, Thailand, Turkey, Ukraine, United Kingdom, United States of America) invited to participate.The editor of Thyroid FNA Cytology, Differential Diagnoses and Pitfalls has intentionally provided several topics in duplicate chapters by different authors to show you how they are handled differently, so that readers may select the most suitable and appropriate one related to each reader’s thyroid practice and FNA cytology. This book offers a comprehensive guide to thyroid fine needle aspiration (FNA) cytology. Borderline/precursor tumors, which were introduced in the 4th edition of the WHO classification of thyroid tumors, are also incorporated. In this second edition, prominent international experts discuss the different approaches to thyroid FNA cytology employed in various countries such as Australia, Canada, China, Korea, Portugal, Switzerland, Taiwan, Thailand, Turkey, Ukraine, the USA, UK, Italy and Japan. The book not only covers key principles of thyroid cytopathology but also addresses technical aspects such as procedural complications, liquid-based cytology, immunocytochemistry, staining procedures, and potential pitfalls. Case-based descriptions and clinical findings, radiologic imaging, cytology, and histopathologic diagnosis – all complemented by a wealth of detailed photographs – will help reader understand and overcome many common dilemmas in daily practice. As such, the book represents an indispensable reference work for all cytopathologists, especially those practicing thyroid cytopathology.

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Asian Working Group Companion Meeting in the 20th ICC Sydney.


The 3rd Asian WG Companion Meeting

The 3rd Asian WG Companion Meeting

The 20th ICC Sydney was over with great success. Asian Working Group companion meeting was held on the 8th of May (Figure 1), and we had the third face to face meeting. Gradually we found significant differences in thyroid practice among Asian WG members as well as between Asian and Western thyroid practice more and more. We are proudly showed our recent activities.

Multi-institutional Studies in 2018 and 2019.

1.    Bychkov A et al. Impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features on the Bethesda system for reporting thyroid cytopathology: a multi-institutional study in five Asian countries. Pathology 2018; 50:411-417.

2.    Bychkov A et al. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features in Asian practice: Perspectives for surgical pathology and cytopathology. Endocr Pathol. 2018; 29:276-288.

3.    Vuong HG et al. Clinical impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features on the risk of malignancy in the Bethesda system for reporting thyroid cytopathology: a meta-analysis of 14,153 resected thyroid nodules. Endocr Pract. 2019 [Epub ahead of print]

4.    Agarwal S et al. The prevalence and surgical outcomes of Hürthle cell lesions in fine‐needle aspirates of the thyroid: A multi-institutional study in six Asian countries. Cancer Cytopathol. 2019; 127:181-191.

5.    Liu Z et al. Interobserver and intraobserver variation in the morphological evaluation of noninvasive follicular thyroid neoplasm with papillary like nuclear features in Asian practice. Pathol Int. 2019 [Epub ahead of print]

6.    Kakudo K et al. To the Editor. Cytologically borderline thyroid nodules as a key target to reduce overdiagnosis and overtreatment of thyroid cancer. Arch Pathol Lab Med (Accepted for publication).

Please join us at the 58th JSCC Fall Meeting in Okayama, Japan. You and new members are also welcome to this activity. Please contact me at The following are details for the 4th face to face meeting (the Global Asian Forum) on 16th of November in Okayama, Japan.

The Global Asian Forum: Thyroid FNA Cytology in Asian Countries.


1.    Andrey Bychkov, MD, Ph.D., Department of Pathology, Kameda Medical Center, Kamogawa, Japan,

2.    Kennichi Kakudo, MD, Ph.D., FIAC, Department of Pathology, Kindai University Faculty of Medicine, Nara Hospital, Ikoma, Japan,

A welcome message by the meeting president, professor Moriya


1.    Chan Kwon Jung, MD, Ph.D., Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Korea,

Topic: Nuclear features of BRAF mutated PTCs and RAS-mutated neoplasms.

2.    Shipra Agarwal, MD, DNB, Department of Pathology, All India Institute of Medical Sciences, India,

Topic: AUS/FLUS in Indian experience with thyroid FNA.

2.    Priyanthi Kumarasinghe, MD, Department of Anatomical Pathology, University of Western Australia, Australia,

Topic: BRAF testing to refine cytology categories: how and when?

4.    Huyen-Trang Vu, MD, Department of Pathology, Ho Chi Minh City Oncology Hospital, Ho Chi Minh City, Vietnam,

Topic: Resection rate and risk of malignancy among TBSRTC categories in Western vs. Asian practice.

5.    Chih-yi Liu, MD, FIAC, Division of Pathology, Sijhih Cathay General Hospital, New Taipei City, Taiwan,

Topic: Cytological diagnosis of medullary thyroid carcinoma among Asian Working Group in Thyroid Cytology.

6.    Yaqiong Li MD Ph.D., Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong, China,

Topic: Observer variation study in the diagnosis of follicular neoplasms.


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