Jen Ai Hospital

- Hepatocellular carcinoma (HCC) is increasingly driven by non-viral causes, especially metabolic dysfunction-associated steatotic liver disease (MASLD), which is common in type 2 diabetes mellitus (T2D). No pharmacologic agent is currently approved for HCC chemoprevention.

- To evaluate the association between sodium-glucose cotransporter-2 inhibitor (SGLT2i) use and risks of HCC and all-cause mortality in patients with MASLD and T2D.

- Multinational, retrospective cohort study using the TriNetX federated electronic health record network (2005-2025). Adults aged 18-90 years with non-viral MASLD and pre-existing T2D were identified. We applied a 1-year washout, used an active-comparator design, and performed 1:1 propensity score matching. Adjusted hazard ratios (aHRs) were estimated with Cox models.

- After matching, 93,930 SGLT2i users were compared with 93,930 active comparators with excellent covariate balance. Median follow-up was 3.24 years (IQR 1.72-5.09) in the SGLT2i group and 3.25 years (IQR 1.72-5.08) in comparators. HCC occurred in 43 (0.05 %) SGLT2i users vs 74 (0.08 %) comparators (aHR 0.43; 95 % CI 0.29-0.63). All-cause mortality was 5.32 % vs 10.50 % (aHR 0.34; 95 % CI 0.33-0.35). Results were consistent across subgroups and sensitivity analyses, including time-anchored landmark analyses. Risk reductions were also observed for liver fibrosis/cirrhosis and hepatic nodules.

- Among patients with MASLD and T2D, SGLT2 inhibitor use was associated with lower risks of HCC and all-cause mortality compared with active comparators. While residual confounding cannot be excluded, these findings support prospective evaluation of SGLT2 inhibitors for liver-related risk reduction in this population.

Pancreatic perivascular epithelioid cell tumors (PEComas) are exceedingly rare mesenchymal neoplasms that often mimic neuroendocrine tumors (NETs) in their clinical and radiologic presentation, making preoperative diagnosis challenging. We report the case of a 67-year-old female with a 1.7 cm pancreatic body tumor initially suspected to be a NET. Preoperative chromogranin A levels were within the normal range. The patient underwent central pancreatectomy, and histopathological examination revealed a neoplasm composed of epithelioid cells arranged in sheets and cords within a hyalinized stroma. The tumor cells exhibited vesicular nuclei with distinct nucleoli and eosinophilic to clear cytoplasm. Although nuclear pleomorphism was present, no increased mitotic activity or tumor necrosis was identified. Immunohistochemistry was positive for HMB-45 and Melan-A, confirming the diagnosis of pancreatic PEComa. This report underscores the diagnostic challenge of pancreatic PEComas, which can closely resemble NETs, and highlights the importance of immunohistochemistry in establishing a definitive diagnosis.