of Week Home
17 September 2014 - Case of the Week #326
All cases are archived on our website. To view them sorted by number, diagnosis or category, visit our Home Page and click on the Case of the Week button on the left hand side. To subscribe or unsubscribe to the Case of the Week or our other email lists, click here.
Thanks to Dr. Ankur Sangoi, El Camino Hospital, California (USA), for contributing this case. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.
(1) Do you use Amazon.com? Support PathologyOutlines! If you buy a book, or anything else, from Amazon.com by clicking on the banners / links located on our website, Amazon pays us a small percentage from their profits - without raising consumer prices. Or click here. Thanks!
(2) We enjoy seeing and talking with the pathology community at the conferences we attend, and CAP '14 is no different. Thanks again to everyone who stopped by. Pictures are available on our Blog and Facebook page.
(3) Our Feature page for September is Antibodies / Biomarkers, and highlights our advertisers Advanced Cell Diagnostics, Inc. (ACD) and Leica Biosystems. It also contains an original short article, “Antibodies in Pathology: The Role of Multiplex Immunohistochemistry”, by Jaleh Mansouri, M.D. This past August was the best August we've ever had in terms of traffic - up 32% from last year!
(4) Did you know that PathologyOutlines.com offers you an opportunity to quickly and easily compare products and services offered by various companies? Check out all of the Surveys we have posted for Computer Systems-AP/LIS, Imaging / Digital / Photography and Reference Laboratories to help find what you're looking for. We plan on adding additional surveys in the next few months.
(5) Visit our Updates page to see what topics have been revised based on reviews or new images.
Case of the Week #326
A 34 year old woman had "perineal cysts" that were biopsied. She was an avid cyclist.
What is your diagnosis?
Perineal nodular induration
Perineal nodules are rare reactive lesions reported in male and female cyclists and equestrians, due to repetitive perineal trauma (Hautarzt 2000;51:763, Int J Gynecol Pathol 2010;29:398). They have also been termed cyclist's nodule, reactive fibroblastic and myofibroblastic proliferation of the vulva, and "third testicle of the cyclist" (Histopathology 2003;42:615). In women, a recent report describes 4 cases of unilateral nodules or swellings of the labium major in competitive cyclists ages 15-45 years (Am J Surg Pathol 2011;35:110). Histologically, there was a mixture of adipose tissue, hyalinized tissue with bland spindled fibroblasts, blood vessels and nerve fibers, with variable perivascular lymphocytic infiltrate, thick cords of fibrous tissue, elastic fibers and epithelioid, plasmacytoid or ganglion-like cells.
The spindle cells cells were immunoreactive for estrogen receptor and plump mesenchymal cells were positive for smooth muscle actin, consistent with myofibroblasts. These cells were negative for desmin, S100, CD34 (but see Int J Surg Pathol 2014;22:71) and HMGA2.
The differential diagnosis includes various other mesenchymal lesions, which have a different clinical setting.
These lesions are benign, but may recur. In this case, after cessation of cycling and rest, the nodule went away.
Nat Pernick, M.D., President
and Shivani Thakore, Associate Medical Editor
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Alternate email: NatPernick@gmail.com