Madelung Disease of the Scrotal Region: A Case Report

Introduction: Madelung disease is a rare disorder characterized by symmetrical fat accumulation, typically around the neck, shoulders, and trunk. Case Presentation: A 56-year-old man presented for 10-month history of dysuria and painless swelling of the lower abdomen and scrotum. A large scrotal mass completely buried the penis, and cranially displaced both testes. Contrast-enhanced magnetic resonance imaging suggested a well differentiated liposarcoma but whole-body computed tomography revealed symmetrical fat accumulation in the upper body trunk, raising suspicion of Madelung disease. Biopsy of the mass confirmed a benign lipoma. Excision of a 664 g lipoma improved the patient's penile configuration, enabling him to urinate in a standing position. Conclusion: Madelung disease in the scrotal region is rare, only nine cases reported to date. However, it should be considered when bilateral symmetrical fat accumulation is present because a correct diagnosis has a decisive impact on treatment strategy.