Perineal nodular swelling in a recreational cyclist

Perre, Stefaan Van de; Vanhoenacker, Filip; Vanstraelen, Luc; Gaens, J; Michiels, Maarten

doi:10.1007/s00256-009-0730-x

Cited by 3 publications

(3 citation statements)

References 3 publications

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“…Chronic lymphedema resulting in the development of fibrous tissue has also been suggested as an etiological pathway of PNI [4]. Histopathological findings vary but tend to show necrosis of the superficial perineal fascia with myxoid degeneration of collagen fibers and fatty tissue, as well as occasional formation of a central pseudocyst [2][3][4][5]12,15]. In large PNIs, the skin condition with non-healing, exuding wounds often resembles other lymphatic problems, such as elephantiasis.…”

Section: Discussionmentioning

confidence: 99%

“…The PNI manifests as two nodules, with one on each side of the perineal raphe; in other cases, it presents as a single nodule [1]. This localization of the swelling led to reports in journals on various medical disciplines, such as urology [2,8], gynecology [9,10], dermatology [1,3], orthopedic surgery [11] and plastic surgery, as well as histopathology [4,12] and radiology [13][14][15]. Overall, PNI is a rare disease and the knowledge about its treatment is limited.…”

Section: Introductionmentioning

confidence: 99%

“…This includes the alteration of the cause, namely adjustment of the rider's position on the saddle and wearing appropriate cycling pants. Rest alone was reported as not resulting in spontaneous regression of the mass [2,15]. However, further progression could be stopped by avoiding cycling.…”

Section: Introductionmentioning

confidence: 99%

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How to Treat a Cyclist’s Nodule?—Introduction of a Novel, ICG-Assisted Approach

Mayer,

Spies,

Mayer

et al. 2024

JCM

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Background: Perineal nodular induration (PNI) is a benign proliferation of the soft tissue in the perineal region that is associated with saddle sports, especially road cycling. The etiology has not been conclusively clarified; however, repeated microtrauma to the collagen and subcutaneous fat tissue by pressure, vibration and shear forces is considered a mechanical pathomechanism. In this context, chronic lymphedema resulting in the development of fibrous tissue has been suggested as an etiological pathway of PNI. The primary aim of this study was to introduce and elucidate a novel operative technique regarding PNI that is assisted by indocyanine green (ICG). In order to provide some context for this approach, we conducted a comprehensive review of the existing literature. This dual objective aimed to contribute to the existing body of knowledge while introducing an innovative surgical approach for managing PNI. Methods: We reviewed publications relating to PNI published between 1990 and 2023. In addition to the thorough review of the literature, we presented our novel surgical approach. We described how this elaborate approach for extensive cases of PNI involves surgical excision combined with tissue doubling and intraoperative ICG visualization for exact lymphatic vessel obliteration to minimize the risk of recurrence based on the presumed context of lymphatic congestion. Results: The literature research yielded 16 PubMed articles encompassing 23 cases of perineal nodular induration (PNI) or cyclist’s nodule. Of these, 9 cases involved females, and 14 involved males. Conservative treatment was documented in 7 cases (30%), while surgical approaches were reported in 16 cases (70%). Notably, a limited number of articles focused on histopathological or radiological characteristics, with a shortage of structured reviews on surgical treatment options. Only two articles provided detailed insights into surgical techniques. Similarly to the two cases of surgical intervention identified in the literature research, the post-operative recovery in our ICG assisted surgical approach was prompt, meaning a return to cycling was possible six weeks after surgery. At the end of the observation period (twelve months after surgery), regular scar formation and no signs of recurrence were seen. Conclusion: We hope that this article draws attention to the condition of PNI in times of increasing popularity of cycling as a sport. We aimed to contribute to the existing body of knowledge through our thorough review of the existing literature while introducing an innovative surgical approach for managing PNI. Due to the successful outcome, the combination of tissue doubling, intraoperative ICG visualization and postoperative negative wound therapy should be considered as a therapeutic strategy in cases of large PNI.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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How to Treat a Cyclist’s Nodule?—Introduction of a Novel, ICG-Assisted Approach

Mayer,

Spies,

Mayer

et al. 2024

JCM

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Cyclist's nodule: no smooth ride

et al. 2016

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A fit and active amateur cyclist was referred by his general practitioner to a surgical oncology outpatient clinic with a slowly-growing perineal mass. Following clinical examination, the patient underwent imaging and biopsy at a tertiary soft tissue tumour centre, which diagnosed perineal nodular induration: a rare, benign tumour caused by repetitive trauma associated with 'saddle sports' such as cycling or horse riding. It is important to consider soft tissue tumours in patients who present with 'lumps and bumps'; they can occur anywhere in the body including the groin or perineum, where it is sometimes referred to as a 'third' or 'accessory' testicle in men. Although unusual, the case emphasises the importance of rapid specialist referral from primary care, and consideration of a patient's occupation and hobbies when formulating diagnoses.

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US Assessment of Sports-related Hip Injuries

2018

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Traumatic and overuse hip injuries occur frequently in amateur and professional athletes. After clinical assessment, imaging plays an important role in diagnosis and in defining care management of these injuries. Ultrasonography (US) is being increasingly used in assessment of hip injuries because of the wide availability of US machines, the lower cost, and the unique real-time imaging capability, which allows both static and dynamic evaluation as well as guidance of point-of-care interventions such as fluid aspiration and steroid injection. Accurate diagnosis of hip injuries is often challenging, given the complex soft-tissue anatomy of the hip and the wide spectrum of injuries that can occur. To conduct a skillful US evaluation of hip injuries, physicians must have pertinent knowledge of the normal anatomy and should make judicious use of surface anatomy landmarks while using a compartmentalized diagnostic approach. In this article, common sports-related injuries of the anterior, lateral, and posterior hip compartments are discussed. This review includes assessment of joint effusion, acetabular labral tear, acute and chronic tendon injuries including tendinopathy, partial and full-thickness tears, snapping hip syndromes, relevant US-guided procedures, and some other conditions such as Morel-Lavallée lesion and perineal nodular induration. Principles of care management and current knowledge on imaging findings that may affect return to activity are also presented. Using an oriented US examination technique and having knowledge of the normal hip anatomy will help physicians characterize US findings of common sports-related hip injuries and make accurate diagnoses. Online supplemental material is available for this article. RSNA, 2018.

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Perineal nodular swelling in a recreational cyclist

Cited by 3 publications

References 3 publications

How to Treat a Cyclist’s Nodule?—Introduction of a Novel, ICG-Assisted Approach

How to Treat a Cyclist’s Nodule?—Introduction of a Novel, ICG-Assisted Approach

Cyclist's nodule: no smooth ride

US Assessment of Sports-related Hip Injuries

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