多發性對稱性脂肪瘤症（馬德隆氏症）之陰囊表徵：罕見臨床表現與診斷難題

鍾慧明、黃信文 ¹

花蓮基督教門諾會醫院  泌尿科，¹放射科

Scrotal Manifestation of Multiple Symmetric Lipomatosis (Madelung Disease): A Rare Presentation and Diagnostic Challenge  

Hui-Ming Chung, Hsing-Wen Huang¹

Department of Urology,  Department of Radiology¹,

Mennonite Christian Hospital, Hualien, Taiwan

            Multiple symmetric lipomatosis (MSL), also known as Madelung disease, is a rare metabolic disorder characterized by the growth of non-encapsulated, symmetric fatty deposits. While it classically involves the neck (Type I), involvement of the pelvic and scrotal regions (Type II) is exceptionally rare. We present a case of a 39-year-old male with scrotal lipomatosis and a significant history of cervical lipoma, highlighting the importance of systemic evaluation in urological practice.

            A 39-year-old male presented with progressive, bilateral inguinal swelling extending into the scrotum over several months. Physical examination revealed soft, non-tender, symmetric fullness mimicking bilateral inguinal hernias. Notably, the patient had undergone surgical excision of a "neck lipoma" four months prior. Abdominal and pelvic Computed Tomography (CT) was performed for further evaluation.

            CT imaging demonstrated prominent, non-encapsulated, homogeneous fat deposition in the bilateral hemi-scrotum and inguinal canals, without evidence of bowel or omental herniation. The fatty tissue was poorly circumscribed, infiltrating between local fascial planes, a hallmark of Madelung disease. Given the synchronous presentation of cervical and scrotal lipomatosis, a diagnosis of Type II Madelung disease was established. The patient was managed with a multidisciplinary approach focusing on metabolic screening and symptom-guided surgical debulking.

            Madelung disease should be considered in the differential diagnosis of symmetric scrotal or inguinal swelling, especially in middle-aged males with a history of cervical fatty masses. Recognizing this systemic condition is crucial to differentiate it from simple lipomas or hernias, as it carries a high rate of recurrence and is frequently associated with metabolic derangements such as insulin resistance and chronic alcohol consumption.