CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 1, January–April 2023 AFRICA 47 Since the mechanism of growth of an IVL is unknown, it is most effective to continue with postoperative follow up to observe dynamic changes in the IVL, including tumour recurrence. Both a large tumour (≥ 7 cm) and widespread ligament involvement with the tumour are considered risk factors for recurrence.13 It has been reported that, postoperatively, the incidence of the tumour recurring is about 30% and the effect of anti-oestrogen therapy should be further validated.14,15 Yang et al.16 have demonstrated that, clinically, for leiomymatosis peritonealis disseminata, patients with previous surgery, recurrence or unresectable lesions, goserelin, as a long-term conservative treatment, is safe and more effective. An association between localised invasion of the IVL and a total of four tumour biomarkers, VEGF, PDGF, CD44 and bFGF, has been found in a study focusing on markers during postoperative follow up.17 Besides these traditional biomarkers, the potential value of other metabolites, including hypoxanthine, acetylcarnitine, glycerophosphocholine and hydrocortisone, have also been confirmed.18 Conclusion Although benign, IVL with metastases and invasion of tissues is also associated with disordered functioning or even failure of multiple organs during the disease progress. Possible misdiagnosis due to clinical symptoms being similar to other common diseases may lead to delayed treatment early in the course of the disease. Once diagnosis is confirmed, surgery is the first option for treatment of IVL. Clinically, radical surgery through an abdominal–thoracic incision is invaluable. However, the surgical procedure should be individualised, based on the medical information of the patients. 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