Cyclist's Nodule



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Jim Wilson

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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"

<http://www.ualberta.ca/htbin/lwgate/PATHO-L/archives/patho-l.archive.1999-11/subject/> search
for cyclist

<http://link.springer-ny.com/link/service/journals/00105/bibs/0051010/00510763.htm> use Google's
translation service

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
 
C

Cleanbean

Guest
"Jim Wilson" <[email protected]> wrote in message
news:[email protected]...
> 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 Snip research> Keywords: fibromatosis nodule induration ischial
> hygroma fibrous perineal "cyclist's nodule" "deep saddle sore".
>
> Jim Wilson

Interesting! Thanks for sharing. I once had a nodule but it was called inflamed hemoroids. It was
right before the "Hotter N Hell 100 in Whichta Falls, Tx. I got lots of advice here and ended up
still riding with no problem.

John in Texas BCBC
 
J

Jack Kessler

Guest
Kids with glasses used to be called "four eyes". Can old guys with bicycles now be called
"four balls"?

"Jim Wilson" <[email protected]> wrote in message
news:[email protected]...
> 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"
>
>
<http://www.ualberta.ca/htbin/lwgate/PATHO-L/archives/patho-l.archive.1999-1
1/subject/>
> search for cyclist
>
>
<http://link.springer-ny.com/link/service/journals/00105/bibs/0051010/005107
2.htm>
> use Google's translation service
>
> 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
 
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