subserosal uterine fibroid - but still have questions

Hi. Finally I have an answer to the cause of chronic left-sided pelvic pain, but still have questions. Excerpt from  (transabdominal) US is:
"There is a small rounded heterogeneously relatively hypoechoic focus at the uterine fundus to the left of midline most likely representing a small fundal fibroid measuring 2.5 by 1.8  by 1.9 . It is largely subserosal and partially exophytic"

I'm assuming by exophytic it means it's partially unattached and by subserosal that it's on the "outside"/outer layer of uterus. Please correct me if I'm wrong. Here are questions- I apologize in advance for the large number of questions but i could really use your help. They are well thought out  and I was unable to find the answers elsewhere.

Questions:
1) does the partial unattachment mean it's on a stalk that is more likely to twist or wrap around something?
2) it was quiet until a very painful PAP smear set off weeks of pain. Can such an exam stir up trouble for a fibroid? Is there a chance the flare up of pain could subside on its own?
3) what precicely does the heterogenous focus (i'm assuming "uneven") refer to?
4) although fibroid is the most likely cause of the US results, what would the differential diagnosis be? what are other less likely causes of the same scan results?
5) I also have a weak and painful left quadriceps muscle of unknown cause - could this test result explain that also?
6) I thought fibroids should be hyperechoic not hypoechoic like mine- am I just misremembering this?
7) are subserosal fibroids more likely to grow very large than other fibroids?
8) should I rescan at some point to see how fast it's growing, and if so, how long from now
9) 3 years ago I also had long lasting pelvic pain of the same type - yet sonogram showed nothing. What's the odds it could have been missed on a scan 3 years ago, yet still have been there?
10) does its location at the fundus suggest any particular type of potential complication I should be on the look out for?

[Elaine Brown, MD]

Hi!
Yes, you do have good questions!
1)yes, although usually the scan is read  as a pedunculated fibroid if it is on a stalk, so I think yours is probably largely embedded in the wall of the uterus.
2)Yes, and yes,  I wonder if it started to degenerate for some reason--if so, it will get better on its own and the pain will go away
3)heterogeneous means not all the same consistency which is typical of a fibroid
4)fibroid is by far and away the most likely cause--close to 99% odds
5)no the fibroid should not impact your quadriceps
6)hyperechoic would suggest calcification--either way is typical of a fibroid
7)No, all about the same
8)Yes, I would re-check in about 6 months
9)Doubtful
10)Not really, actually, the subserosal fibroids usually cause fewer problems than the submucosal ones--those often cause bleeding problems.

I would suggest periodic (annual) scans to rule out growth or development of new fibroids.

Hope this is helpful!
Dr B

[promethiusII]

Thanks by the way. It was exactly what I was looking for. And in addition, having the info enable me to make the most of my 15 minute visit with the GYN. Youre doing great things on the list- thanks again.