UMMA of the testis is a relatively latc manifestation of syphilis and may
It affects the body of the testis primarily and produces varying degrees of fibrosis and gumma formation. The epididymis usually remains unaltered, but may share in the fibrous or gummatous changes, and eventually become indistinguishable from the testis. The vas, cord, seminal vesicles, and prostate are not affected. The tunica vaginalis is thickened and a t first contains a moderate quantity of fluid. As the disease progresses the fluid may be absorbed and the cavity of the tunica be gradually obliterated by adhesion of its parietal and visceral layers. The appearance of the testis varies according t o the relative proportions of fibrosis and gummatous change. Small gummata may develop a t several points simultaneously so as t o produce a nodular effect on clinical examination. More commonly there is a single large gumma and the testis becomes enlarged, hard, and smooth. On section the tunica albuginea is thickened, and the testicular substance is replaced by syphilitic granulation tissue, fibrous tissue, and necrotic material.
When a gumma softens and comes towards the surface the skin on the anterior aspect of the scrotum becomes edematous and adherent t o the testis. Eventually it breaks down and a gummatous ulcer is formed. The testis may fungate out through the hole.
Congenital syphilis may produce a diffuse fibrosis and atrophy of one or both testes. Gummata are rare. develop many years after the disease was acquired.
The disease may be bilateral.