Cyclist's Nodule

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Jim Wilson

Two months ago, I noticed a marble sized lump in my groin on the inside of my left leg. There was no
pain or other symptom, it was just there. When riding, if I paid attention, I knew it was there, but
there wasn't any discomfort. I'm a 57 year old, 190 pound guy who has ridden about 3-4000 road
miles/year for the last 15 years. I usually ride several recreational centuries a year, the Death
Ride and otherwise 25-60 miles a pop. Maybe once a week in the local hills (sea level, 2000 feet
vertical) but nothing competitive, except against myself, and nothing really obsessive.

Uncertain about what this marble was, and unable to find help online, I scheduled one of my
occasional physicals which started with my doctor asking "Why are you here? You don't usually come
in voluntarily". He identified the marble as a 6-8mm roundish nodule just under the skin in the left
perineum area. He didn't think it was prostate cancer (wrong location and shape) but beyond that
didn't know what it was. Recommendation: have an ultrasound test to find out if the nodule was
cystic or solid.

OK, I join 42 women waiting to have their basketball size lumps ultra sounded. A very professional
lady technician explained her process and showed me the pictures returned by the machine was but
wasn't able to answer the question - what was the nodule? She couldn't find a blood supply to it,
which I took as good news. After the radiologist and my doctor discussed the test, my Doctor thought
that there might be a fatty center, but beyond that he knew it wasn't contributing anything and
recommended it be removed.

Off to see the surgeon. He didn't have any idea what the nodule was either. Easy solution tho,
outpatient surgery the next day to extract the little puppy and hand it over to a Pathologist who
could tell me for sure that it was benign and could at least hang some names on it. I hadn't been
able to learn much about this condition mousing around because I didn't know the right words to
describe it.

Armed with the words my various Doctors used, I found a short list of info bits.

The best brief description was a 1997 Usenet posting: "There is a similar condition known in
professional cyclists. It is basically a fibrous growth due to repetitive stress to the subcutaneous
tissue. One might want to compare it with a callus. In some riders two of these lumps appear in the
perineum that look like a second pair of testicles (talking about cyclist's impotence ... ;-) ).
Still I think you should see a doc to rule out an infection.
Didi Burki MD, Berne/Switzerland"

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I found a summary of this article in English but can't locate the link now. "Vuong P.N, Camuzard P.,
Schoonaert M.F., Perineal nodular indurations ("accessory testicles") in cyclists. Fine needle
aspiration and pathologic findings in two cases. Acta Cytol 1988;
32:86-90." Acta Cytol 1988 Jan-Feb;32(1):86-90

Perineal nodular indurations ("accessory testicles") in cyclists. Fine needle aspiration cytologic
and pathologic findings in two cases.

Vuong PN, Camuzard P, Schoonaert MF

Laboratory of Pathology and Cytology, Bievres, France.

The cytologic and histologic findings from two cases of perineal nodular indurations observed in two
cyclists are reported. These lesions, also referred to as "accessory testicles" or "third testicle"
or "ischial hygromas" of cyclists, consist of a localized aseptic area of necrosis with pseudocyst
formation involving connective tissue in the superficial fascia of the perineum. These histologic
findings, which were seen in the subsequent surgical specimens in these two cases, were reflected in
the fine needle aspiration findings. The aspirates contained few cellular elements, mainly a few
vacuolated histiocytes, against a background of fibrinous material. These indurations, which develop
as a result of repeated, chronic microtrauma to the perineum impressed by the vibration of the
saddle of the bicycle, constitute an authentic handicap for the professional cyclist and are a
contraindication to cycling for amateur cyclists.

Arne Baker mentioned the condition on p182 of his book "Bicycling Medicine".

I'm sharing this in the hope that another rider who finds a surprise guest may have a little better
idea of what's happening.

Keywords: fibromatosis nodule induration ischial hygroma fibrous perineal "cyclist's nodule" "deep
saddle sore".

Jim Wilson
A friend of mine (a doctor and cyclist like myself) had one of these removed.
I used to get something like you describe, I think, these and had them removed. I think mine were
sebaceous cysts . Gary Jacobson Rosendale, NY

"Gearóid Ó Laoi, Garry Lee" <[email protected]> wrote in message
news:[email protected]...
> A friend of mine (a doctor and cyclist like myself) had one of these removed.
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