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

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.