Perineal nodular induration: the ‘third testicle of the cyclist’, an under‐ recognized pseudotumour

Somerhausen, Nicolas de Saint Aubain; Geurde, Bernard; Couvreur, Y

doi:10.1046/j.1365-2559.2003.01592.x

Cited by 37 publications

(41 citation statements)

References 5 publications

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“…It is often characterized by a central pseudocystic space surrounded by fibrous tissue containing fibroblast spindle cells and clusters of small-sized vessels. 7,11,12 The central pseudocystic space somewhat resembles that seen in ischemic fasciitis, which occur in elderly patients over the bony prominences who are often, though not always, immobilized. [13][14][15] Other possible differential diagnoses are listed in Table 1.…”

Section: Discussionmentioning

confidence: 98%

“…7 Beyond cyclists, this complication has been documented in a patient who was an equestrian and another who tested lawn mowers. 8,9 It is more commonly seen in males, but recently, five female cases have been reported.…”

Section: Discussionmentioning

confidence: 99%

“…Although the nodule in our case was mobile, most reports state that it is fixed to the soft tissue or ischial tuberosity, has a fibrous to elastic consistency, and is covered by normal skin. 6,7,11 Perineal nodular induration The histopathological appearance of PNI varies. It is often characterized by a central pseudocystic space surrounded by fibrous tissue containing fibroblast spindle cells and clusters of small-sized vessels.…”

Section: Discussionmentioning

confidence: 99%

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Surgical excision of perineal nodular induration: A cyclist’s third testicle

Awad

Murphy

Gaither

et al. 2017

CUAJ

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Perineal nodular induration (PNI), or biker's nodule, is a rare, bothersome, pseudotumour. Herein, we describe the surgical technique used to treat a healthy cyclist who developed an enlarging PNI for five years that grew into a perineal mass. The mass prevented him from cycling due to worsening discomfort and heaviness. The PNI-associated mass was successfully removed by wide surgical excision and a local advancement flap. Subsequently, the patient resumed cycling. Histopathology report demonstrated a benign lesion with abundant ropy collagen with native smooth muscle, vessels, and rare fibroblast-like spindle cells. With the increasing popularity of cycling, PNI may become more common, and health providers should be aware of this rare entity and how it can be safely removed.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Surgical excision of perineal nodular induration: A cyclist’s third testicle

Awad

Murphy

Gaither

et al. 2017

CUAJ

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“…Although this phenomenon is relatively well known among sports medicine specialists, there has been only limited description of the pathologic findings. 3,8,18,22 As far as we are aware, similar lesions have not been reported in the female population. Unilateral vulval hypertrophy has been described in competitive female cyclists, but the histologic features have not been documented.…”

mentioning

confidence: 92%

“…Various designations have been used, including perineal nodular induration of the cyclist, ischiatic hygroma, accessory testicle, third testicle, or biker's nodule. 3,8,18,22 The lesions usually develop at the site of contact with ischial tuberosities, immediately posterior to the scrotum, thus forming 2 nodules located on each side of the raphe. Although this phenomenon is relatively well known among sports medicine specialists, there has been only limited description of the pathologic findings.…”

mentioning

confidence: 99%

Reactive Fibroblastic and Myofibroblastic Proliferation of the Vulva (Cyclist's Nodule)

McCluggage

Smith

2011

American Journal of Surgical Pathology

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Perineal nodules occurring in male cyclists are reported in the literature, although the histologic features are not extensively documented. There has been little description of similar lesions in the female population. We describe 4 cases in which a vulval nodule or swelling developed in competitive female cyclists aged 15 to 45 years. The lesions were unilateral and occurred on the right or left labium majus (2 cases each). The histologic features were similar in all cases and consisted of a haphazard admixture of adipose tissue, variably cellular hyalinized tissue containing bland spindle-shaped fibroblasts, blood vessels, and nerve fibers. In some areas, thick cords of fibrous tissue imparted a keloid-like appearance. Other histologic features included plump mesenchymal cells with round or ovoid nuclei and abundant eosinophilic cytoplasm resulting in an epithelioid, plasmacytoid, or ganglion-like appearance (2 cases), a lymphocytic infiltrate around blood vessels (3 cases), foci of fat necrosis (1 case), and collections of elastic fibers (2 cases). One case recurred, the histologic features of the recurrent lesion being identical to the original. The overall morphologic appearances, especially in the cases with plump mesenchymal cells, bore some resemblance to proliferative fasciitis. Immunohistochemically, the cells were estrogen receptor positive and the plump mesenchymal cells were smooth muscle actin positive, in keeping with myofibroblasts. Desmin, S100, CD34, and HMGA2 were negative. Pathologists should be aware of this pseudoneoplastic lesion occurring on the vulva, which arises in a specific clinical setting and has the potential to be misdiagnosed as a variety of other mesenchymal lesions. We term this lesion as reactive fibroblastic and myofibroblastic proliferation of the vulva or "cyclist's nodule."

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Fibrous/Myofibroblastic Proliferations of the Vulva

Llanos

Rosenberg

2014

Vulvar Pathology

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Perineal nodular induration: the ‘third testicle of the cyclist’, an under‐ recognized pseudotumour

Cited by 37 publications

References 5 publications

Surgical excision of perineal nodular induration: A cyclist’s third testicle

Surgical excision of perineal nodular induration: A cyclist’s third testicle

Reactive Fibroblastic and Myofibroblastic Proliferation of the Vulva (Cyclist's Nodule)

Fibrous/Myofibroblastic Proliferations of the Vulva

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