CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 1, January–April 2023 AFRICA 45 Discussion In clinical practice, IVL is differentiated from other benign gynaecological tumours, mainly due to malignant biological characteristics, including continuous growth along the vascular system, invasive metastases and various complications. There are four clinical stages during the progression of IVL; stages I to IV. Initially, the lesions of an IVL are localised and found within the uterus or para-uterine tissues (stage I), and then sequentially in the pelvic cavity and iliac vein (stage II), inferior vena cava, renal or liver veins (stage III), and even the right heart system (stage IV, accounting for 10% of all patients with IVL) can be involved.2 Early symptoms of IVL are diffuse and similar to other common diseases. During stage I, similar to a hysteromyoma, both vaginal bleeding and increased menstrual flow as well as other common clinical symptoms are frequently observed. This can easily lead to misdiagnosis and delayed medical intervention. Symptoms in advanced stage II to III are caused due to obstruction of the vena cava, including oedema and ascites. In the final stage IV, symptoms including chest distress and dyspnoea present, caused by heart failure due to involvement of the right heart system. A differential diagnosis between IVL and a common cardiac tumour, for example atrial myxoma, should be performed. Generally, as the most common benign primary cardiac tumour, a myxoma originates and is limited within the atrial, and occasionally, the pulmonary artery, however, the inferior vena cava is hardly ever affected.3 A variety of clinical symptoms caused by myxoma, which present as fever, valvular regurgitation or stenosis, embolism or even sudden death, depend on the size, location and cardiac structure involved.4 The outcome of myxoma is relatively favourable and the incidence is lower in paediatric patients under 10 years, except for Carney complex, which is due to a genetic disorder.5 Fig. 1. The tumour body of the IVL (red arrow) was detected within the abdominal and pelvic cavity, right atrium, inferior vena cava, left renal vein and left ovarian vein. Fig. 2. The complete tumour body of the IVL (red arrow) was removed.
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