A. ABDULLAH ET AL.
2
or “biker’s nodule”, seem to be relatively well known by
European sports medicine specialists as well as profes-
sional or amateur cyclists since they are virtually restrict-
ed to cyclists [1]. Clinically, it usually presents as two
nodules, one on each side of the raphe, although it occa-
sionally presents as a single nodule, which is then called
3rd testicle and is located immediately below the scrotum,
close to the ischial tuberosity [2,3].
Differential diagnoses include common minor disor-
ders such as cysts and lipomas, which can be easily rec-
ognised by ultrasonography. Biker’s nodule should also
be differentiated from another, rarer but more serious
condition known as aggressive angiomyxoma, which is a
variety of myxoid tumor that infiltrate locally and is as-
sociated with a high risk of local recurrence after resec-
tion, but has no metastatic potential.
It is believed that repeated microtrauma to the subcu-
taneous fatty tissue or collageneous tissue, caused by
pressure or vibration exerted by the bicycle's saddle on
the perineal region, lead to collagenous degeneration, my-
xoid alteration and pseudocyst formation, resulting in
biker’s nodule [4].
The treatment of these nodules mainly consists of re-
ducing the causative factors, which may lead to regression,
but surgical excision is most often needed. Steroid or hya-
luronidase injections may be helpful in early le sions and
if the patient is a professional cyclist, since surgical exci-
sion is a very difficult option in that case.
3. Conclusion
Biker’s nodule is a rare and benign entity but it represents
a genuine handicap for professional cyclists and can con-
traindicate cycling.
REFERENCES
[1] N. De Saint Aubain Somerhausen, B. Geurde and Y.
Couvreur, “Perineal Nodular Induration: The Third Tes-
ticle of the Cyclist: An Under-Recognized Pseudotu-
mour,” Histopathology, Vol. 42, No. 7, 2003, pp. 615-
616. doi:10.1046/j.1365-2559.2003.01592.x
[2] P. N. Vuong, C. T. Camuzard and M. F. Schoonaert,
“Perineal Nodular Indurations (Accesory Testicles) in
Cyclists, Fine Needle Aspiration Cytologic and Patho-
logic Findings in Two Cases,” Acta Cytologica, Vol. 32,
No. 1, 1988, pp. 86-90.
[3] R. González-Pérez, L. Carnero, N. Arbide and R. Soloeta,
“Perineal Nodular Induration in Cyclists,” Actas Dermo-
Sifiliograficas, Vol. 100, 2009, pp. 907-922.
[4] P. Kohler, S. Utermann, B. Kahle and W. Hartschuh,
“Biker’s Nodule—Perineal Nodular Induration of the Cy-
clist,” Hautarzt, Vol. 51, No. 10, 2000, pp. 763-765.
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