Intrahepatic cholangiocarcinoma (ICC) is the second most common primary hepatic malignancy, with mass-forming growth pattern being the most common. The typical imaging appearance of mass-forming ICC (mICC) consists of irregular ring enhancement in the arterial phase followed by the progressive central enhancement on portal venous and delayed phases. However, atypical imaging presentation in the form of hypervascular mICC might also be seen, which can be attributed to distinct pathological characteristics. Ancillary imaging features such as lobular shape, capsular retraction, segmental biliary dilatation, and vascular encasement favor the diagnosis of mICC. Nevertheless, these radiological findings may also be present in certain benign conditions such as focal confluent fibrosis, sclerosing hemangioma, organizing hepatic abscess, or the pseudosolid form of hydatid disease. In addition, a few malignant lesions including primary liver lymphoma, hemangioendothelioma, solitary hypovascular liver metastases, and atypical forms of hepatocellular carcinoma (HCC), such as scirrhous HCC, infiltrative HCC, and poorly differentiated HCC, may also pose a diagnostic dilemma by simulating mICC in imaging studies. Diffusion-weighted imaging and the use of hepatobiliary contrast agents might be helpful for differential diagnosis in certain cases. The aim of this manuscript is to provide a comprehensive overview of mICC imaging features and to describe useful tips for differential diagnosis with its potential mimickers.

Approximately 20% of patients with colorectal cancer (CRC) are diagnosed with a mucinous subtype of this tumor, have a worse prognosis, and often show resistance to available therapies. Molecules from the mucin family are involved in the regulation of epithelial–mesenchymal transition (EMT), which significantly determines the cancer aggressiveness. This study aimed to examine the diagnostic and prognostic significance of mucinous histology and EMT markers in patients with early-onset CRC and their association with disease severity and tumor characteristics. This study included tumor tissue samples from 106 patients diagnosed with CRC before the age of 45, 53 with mucinous and 53 with non-mucinous tumors. The EMT status was determined by immunohistochemical analysis of E-cadherin and Vimentin in tissue sections. Mucinous tumors had significantly higher Mucin-1 (p < 0.001) and cytoplasmic E-cadherin (p = 0.043) scores; they were significantly less differentiated (p = 0.007), more advanced (p = 0.027), and predominately affected right the colon (p = 0.039) compared to non-mucinous tumors. Epithelial tumors were significantly better differentiated (p = 0.034) and with less prominent tumor budding (p < 0.001) than mesenchymal tumors. Mucin-1 and Vimentin were independent predictors of tumor differentiation (p = 0.006) and budding (p = 0.001), respectively. Mucinous histology and EMT markers are significant predictors of disease severity and tumor characteristics in early-onset colorectal cancer.

Colorectal cancer (CRC) is a leading cause of morbidity and mortality worldwide, with varying trends in tumor pathology depending on geographic and demographic factors. The aim of this study was to describe trends in tumor pathology in Serbian patients with colorectal cancer (CRC) over a 14-year period, from 2003 to 2016. The study included patients referred from local units to the tertiary center for CRC treatment during the entire observation period, as well as patients diagnosed within the national screening program during the last four years. Resections were performed in 2462 patients (1465 men, 60% and 997 women, 40%) with an average age of 62±12 years, and the incidence was equally distributed between genders. Rectal tumors were noted in 54% of patients, while in 46% of patients tumors were found in the colon (32% in the left and 14% in the right colon). The majority of patients were in an advanced stage of the disease, with only 12% of cases with Dukes A stadium. Patients with early-onset disease represented between 11% and 22% of all cases per year. Among early-onset patients, women were significantly overrepresented (P=0.013), patients were diagnosed at significantly later stages (P=0.033), tumors were significantly less differentiated (P=0.001) and tumors of the right colon were overrepresented (P<0.001). A group of patients who underwent neoadjuvant chemoradiotherapy consisted of 235 men and 88 women with an average age of 60±12 years. Within this group, 20% of patients had a good response, 37% a moderate response, and 43% a poor response. The study has provided valuable insight into trends in tumor pathology in Serbian CRC patients and confirmed the beneficial effects of the introduction of the national screening program.

Approximately 20% of patients with colorectal cancer (CRC) are diagnosed with a mucinous subtype of this tumor, have a worse prognosis, and often show resistance to available therapies. Molecules from the mucin family are involved in the regulation of epithelial-mesenchymal transition (EMT), which significantly determines the cancer aggressiveness. This study aimed to examine the diagnostic and prognostic significance of mucinous histology and EMT markers in patients with early-onset CRC and their association with disease severity and tumor characteristics. The study included tumor tissue samples from 106 patients diagnosed with CRC before the age of 45, 53 with mucinous and 53 with non-mucinous tumors. The EMT status was determined by immunohistochemical analysis of E-cadherin and Vimentin in tissue sections. Mucinous tumors had a significantly higher cytoplasmic E-cadherin score (P=0.043), they were significantly less differentiated (P=0.007), more advanced (P=0.005), and predominately affected right colon (P=0.030) in comparison to non-mucinous tumors. Epithelial tumors were significantly better differentiated (P=0.034) and with less prominent tumor budding (P < 0.001) than mesenchymal tumors. The process of EMT appears to be more prominent in tumors of younger patients regardless of mucinous histology. EMT status may represent a useful prognostic tool in early-onset CRC.

Hepatic echinococcosis, caused by Echinococcus species, remains a significant global health concern, with cystic echinococcosis (CE) being widespread and alveolar echinococcosis (AE) representing a rarer but more aggressive form. CE generally demonstrates characteristic imaging features, allowing straightforward diagnosis, whereas atypical presentations can closely mimic other hepatic lesions, leading to diagnostic uncertainty. AE poses an even greater diagnostic challenge due to its infiltrative, tumor-like growth pattern. Magnetic resonance imaging (MRI), with its superior soft-tissue contrast and multiplanar capabilities, plays a crucial role in the evaluation of AE and atypical CE cases. This pictorial review summarizes MRI features of hepatic echinococcosis, detailing both typical and atypical appearances, and emphasizes key criteria for differentiating hydatid cysts from other cystic or solid hepatic lesions. By consolidating imaging findings and discussing relevant differential diagnoses, this review aims to improve diagnostic accuracy, guide clinical management, and increase radiologists’ awareness of echinococcosis in both endemic and non-endemic regions.

Colorectal cancer (CRC) is the third most frequently diagnosed cancer and the second most common cause of death among malignant neoplasms, including both sexes. The most important prognostic and predictive factors for CRC are the histological type and grade of the tumor, TNM stage of the tumor disease, lympho-vascular and perineural infiltration, tumor budding and residual status. The molecular classification of CRC is based on its genetic characteristics, cellular specifications, cancer microenvironment and immunological characteristics, and is of great practical importance, as individual subtypes differ in their clinical course and respond differently to chemotherapeutic and biological treatment. Epithelial-mesenchymal transition (EMT) is a trans differentiation process in which epithelial cells acquire properties that are characteristic of mesenchymal cells. During neoplastic progression, cancer cells acquire genetic and epigenetic features that affect oncogenic and tumor suppressor genes, which ultimately results in the activation of the type III EMT program, giving them the potential to invade and metastasize, contributing to the stemness of cancer cells, their resistance to drugs and immune response avoidance. Changes made in cells, during EMT, can be reversible upon arrival at a suitable location for colonization, by a process opposite to EMT, called mesenchymal-epithelial transition (MET), during which cells regain characteristics of the epithelial phenotype. In most human cancer types, a complete shift from an epithelial to a mesenchymal phenotype during EMT is rarely encountered, but most cancers show partial EMT. Cells undergoing partial EMT are difficult to identify, due to their phenotypic heterogeneity and variable expression of EMT markers. It is necessary to find new biomarkers of EMT, especially partial EMT, as well as a better understanding of the relationship between EMT and resistance to therapy, in order to develop new therapeutic approaches for CRC.