CASE REPORT article
Front. Oncol.
Sec. Cancer Imaging and Image-directed Interventions
Madelung's Disease Involving the Scrotum: A Case report and Diagnostic Pitfalls with Liposarcoma
Shu-hui Wang
Weiwei Yu
Department of Radiology, Weihai Municipal Hosipital, Cheeloo College of Medicine, Weihai, China
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Abstract
Background: Madelung's disease is a rare metabolic disorder characterized by diffuse, symmetrical adipose tissue proliferation, strongly associated with chronic alcohol consumption. Scrotal involvement is exceedingly rare and can mimic malignancy. Case Presentation: We report a 59-year-old man with a history of chronic alcohol intake who presented with progressive bilateral scrotal enlargement. Unlike previously reported cases of scrotal Madelung's disease, which typically demonstrate homogeneous and unencapsulated fat proliferation, MRI in this patient revealed atypical imaging features, including multiple internal fibrous septa and distinct nodular-like foci within fat-containing scrotal masses, raising suspicion of liposarcoma. Complete surgical excision was performed. Histopathology confirmed benign lipomatosis with CDK4(+), MDM2(+), Ki-67 (+,2%), and negative MDM2 amplification on fluorescence in situ hybridization (FISH), arguing against well-differentiated liposarcoma. The patient remained recurrence-free at 12-month follow-up. Conclusion: This case emphasizes the critical role of multimodal medical imaging, rigorous histopathological evaluation, and molecular testing in establishing an accurate diagnosis and guiding appropriate management, while highlighting that Madelung's disease may occasionally present with atypical imaging features, such as nodules and septa which closely mimic a malignant lesion.
Summary
Keywords
differential diagnosis, Liposarcoma, Madelung's disease, Magnetic Resonance Imaging, Multiple symmetric lipomatosis, Scrotum
Received
10 September 2025
Accepted
20 February 2026
Copyright
© 2026 Wang and Yu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Shu-hui Wang
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