{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T10:27:17Z","timestamp":1787740037152,"version":"build-2784847793"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"C","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2020,7,13]],"date-time":"2020-07-13T00:00:00Z","timestamp":1594598400000},"content-version":"vor","delay-in-days":194,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cycling is known to cause groin pain, typically adductor\/hamstring strains and \u201csaddle sores\u201d (skin abrasion, ulceration and\/or folliculitis). Rarely does it result in pathological mesenchymal lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Presentation of case<\/jats:title>\n                    <jats:p>We report a case of a 52-year-old female avid cyclist with chronic groin pain. Activity alteration, bike fit, and saddle modification did not ameliorate her symptoms. MRI revealed no hamstring or bony abnormality but demonstrated low T1\/high T2 signal in the right perineum inferior to the ischial tuberosity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Perineal nodular induration, or \u201ccyclist\u2019s nodule,\u201d is a reactive fibroblastic and myofibroblastic pseudotumor almost exclusively reported in male cyclists. PNI can become so nodular that it has even been referred to as an accessory testicle or \u201cthe cyclist\u2019s third testicle.\u201d<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We report an unusual case of PNI in a female cyclist and review the differential diagnosis of non-infectious soft tissue perineal pain in cyclists. Clinicians should be aware of this rare condition to avoid confusion with other mesenchymal lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1016\/j.ijscr.2020.07.029","type":"journal-article","created":{"date-parts":[[2020,7,15]],"date-time":"2020-07-15T11:52:08Z","timestamp":1594813928000},"page":"277-280","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":10,"title":["\u201cBumpy\u201d ride for the female cyclist"],"prefix":"10.1097","volume":"73","author":[{"given":"Mackenzie","family":"Norman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Vitale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R3-65-20260114","doi-asserted-by":"crossref","first-page":"E244","DOI":"10.5489\/cuaj.4169","article-title":"Surgical excision of perineal nodular induration: a cyclist\u2019s third testicle","volume":"11","author":"Awad","year":"2017","journal-title":"Can. 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Fine needle aspiration cytologic and pathologic findings in two cases","volume":"32","author":"Vuong","year":"1988","journal-title":"Acta Cytol"},{"key":"R11-65-20260114","doi-asserted-by":"crossref","first-page":"288","DOI":"10.5489\/cuaj.4716","article-title":"A rare case of suspected perineal nodular induration","volume":"11","author":"Floyd","year":"2017","journal-title":"Can. Urol. Assoc. J"},{"key":"R12-65-20260114","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.1016\/S0140-6736(00)02852-X","article-title":"Subclinical microtraumatisation of the scrotal contents in extreme mountain biking","volume":"356","author":"Frauscher","year":"2000","journal-title":"Lancet"},{"key":"R13-65-20260114","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1097\/PGP.0b013e3181ce1341","article-title":"Perineal nodular induration: a trauma-induced mass in a female equestrian","volume":"29","author":"Devers","year":"2010","journal-title":"Int. J. Gynecol. Pathol"},{"key":"R14-65-20260114","first-page":"414","article-title":"Biker\u2019s nodule : a case report and review of the literature, Acta Chir","volume":"114","author":"Peters","year":"n.d.","journal-title":"Belg"},{"key":"R15-65-20260114","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1007\/s00256-009-0731-9","article-title":"Perineal nodular swelling in a recreational cyclist: diagnosis and discussion","volume":"38","author":"van de Perre","year":"2009","journal-title":"Skeletal Radiol"},{"key":"R16-65-20260114","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1016\/j.radcr.2020.05.006","article-title":"MR imaging findings in perineal nodular induration (\u201ccyclist\u2019s nodule\u201d): a case report","volume":"15","author":"de Cima","year":"2020","journal-title":"Radiol. 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