The complex immune system of the liver has a major role in tumor surveillance, but also partly explains why current immune therapies are poorly effective against liver cancers. Known primarily for its tolerogenic capacity, the hepatic immune repertoire also comprises diverse populations of armored immune cells with tumor surveillant roles. In healthy people, these work together to successfully identify malignant cells and prevent their proliferation, thus halting tumor formation. When frontline hepatic immune surveillance systems fail, compromised hepatic immunity, driven by obesity, infection, or other pathological factors, allows primary or secondary liver cancers to develop. Tumor growth promotes the normal tolerogenic immunological milieu of the liver, perhaps explaining why current immunotherapies fail to work. This review explores the complex local liver immune system with the hope of identifying potential therapeutic targets needed to best overcome immunological barriers in the liver to create an environment no longer hostile to immunotherapy for the treatment of liver cancer.

Background International doctors make up nearly half of the physicians working in Ireland and are an integral part of the health service. The COVID-19 pandemic declared in March 2020 led to a global healthcare emergency. Resulting national lockdowns precluded travel at a time of need for family support. Aim We aimed to measure the professional, psychosocial, and financial impact of the COVID-19 pandemic on non-EEA doctors working in Ireland. Methods An 88-item online survey of demographics, well-being, and financial resilience was circulated nationally between November 2021 and January 2022. The results were analysed using RStudio and Microsoft Excel 365. Results One hundred thirty-eight responses were received. Sixty-two percent of responders reported wishing to stay in Ireland long-term and 44% had applied for citizenship. Despite 80% of responders working in their desired speciality, only 36% were on a specialist training scheme. Forty-seven percent felt their career was affected by the COVID-19 pandemic. Seventy-three percent of respondents reported missing significant events in their home country. Over 50% reported significant mental health issues personally or in their families; however, only a minority sought professional help. Financial issues were a source of anxiety for 15% of respondents. Financial resilience was poor, 20% of respondents cited a 1-month financial reserve, 10% had a personal pension, and 9% had made a will. Conclusions The COVID-19 pandemic has had a multifactorial negative impact on non-national doctors working in Ireland. More must be done to offer multidimensional support to this cohort who are a crucial part of the underserviced Irish healthcare system.

Background: External compression, thrombosis, or stenosis of the superior vena cava can lead to superior vena cava syndrome, a diagnosis that should be considered swiftly in patients presenting with classic symptoms such as facial and neck swelling, plethora, and distended neck veins. Case Presentation: We report a case of acute port-a-cath associated superior vena cava thrombosis in a longstanding, previously uncomplicated vascular access device in a patient with stable ER+/PR+/HER2+ metastatic breast cancer. After initial treatment, there was limited clinical improvement with subcutaneous low molecular weight heparin (LMWH). Following multidisciplinary team discussion, catheter-directed thrombolysis was performed, which resulted in complete symptom resolution. Conclusion: The recognition of signs and symptoms is crucial in diagnosing acute superior vena cava syndrome, particularly in patients with a malignancy history or a central venous access device in situ. The thrombotic complications of port-a-cath symptoms can occur at any time and management should be guided by multidisciplinary discussion. In appropriately selected patients, catheter-directed thrombolysis can be successful and can lead to rapid symptom resolution.

Background: Adjuvant chemotherapy has been an integral component of breast cancer care for decades. Advances in supportive care have been made, but despite this, infective complications of therapy remain a significant toxicity concern. Case Presentation: A premenopausal patient presented to the emergency department during the third wave of the Covid-19 pandemic with sepsis after a second course of adjuvant docetaxel-cyclophosphamide chemotherapy. Overnight she developed tetraplegia. An urgent MRI cervical spine revealed a pre-vertebral, vertebral, and epidural abscess. This was treated with an emergency C4-C7 posterior cervical laminectomy and decompression. Her inpatient care involved a protracted ICU admission followed by rehabilitation. She remains tetraplegic and requires continued inpatient care over a year after presentation. Restricted pandemic-related hospital visiting has compounded the impact of her illness. Conclusion: Infective complications of adjuvant breast cancer chemotherapy remain an issue despite advances in supportive care. This case highlights the devastating, life-altering impact that these complications can have as emphasized by the inclusion of the patient’s perspective.

Spontaneous regression of metastatic disease in the setting of advanced cancer is a poorly understood clinical phenomenon which occurs infrequently across all tumour types but exceptionally rarely in soft tissue sarcomas. Extraskeletal myxoid chondrosarcoma (EMC) is a rare subtype of soft tissue sarcoma that is poorly responsive to systemic treatment, providing limited options to patients with metastatic disease. We report spontaneous regression of lung metastases in a patient with EMC after re-resection of the primary tumour, which was performed with palliative intent for symptom control after multiple lines of systemic treatment. The patient has remained disease-free and is now more than 5 years post-surgery. To our knowledge, this is the first described case of spontaneous regression of metastatic disease following resection of a primary tumour in a patient with EMC.