原发还是转移的？

 I agree with above diagnosis solely based on a few photos here. However, There are couple more important  issues related to this case.

1) You should always consider if cervical biopsy or ECC represents the full picture and worry if we miss invasive adenocarcinoma on a biopsy due to sampling reason, since biopsy or ECC will never be deep enough for us to evaluate stromal invasion especially microinvasion, unless it is too obvious. You can only evaluate invasiveness on Conization or hysterectomy specimens. Therefore, the diagnosis will be: " Adenocarcinoma in situ and definitive invasion is not seen on this biopsy specimen" Then I will have a COMMENT: " The nature of small biopsy precludes evaluation of stromal invasion. Conization is required to rule out invasive adenocarcinoma".

2) This patient has a SIGNIFICANT clinical history, ,that is, a "pelvic mass". You need communicate with clinician and get some information about this pelvic mass. If image studies indicate the pelvic mass is malignant, then you have to realy think about a underlying invasive adenocarcinoma of the cervix.

I hope this is helpful to fuel the discussion here.

abin译：

仅根据这引起图像，我同意上述诊断。然而有两个重要问题。
1）必须考虑到宫颈活检或ECC标本是否代表全部图像，必须担心活检标本是否会由于采样/取材局限而漏诊浸润性腺癌，因为活检或ECC取材绝不会足够深到足以评价间质浸润特别是微小浸润，除非病变太明显了。只能在锥切或子宫切除标本中评价浸润。因此，诊断应当为“原位腺癌，活检标本中未见明确浸润”，然后加上评注“小块活检标本不能评价间质浸润。需要做锥形切除以排除浸润性腺癌”。
2）患者有重要的临床病史，即“盆腔包块”。需要与临床交流，获取它的信息。如果影像学提示它是恶性，那么真要考虑宫颈潜伏着一个浸润性腺癌。
希望有助于激发讨论。

The specimen consists of polypoid and large fragments of endocervical mucosa involved by irregular glands with cytologic atypia, brisk mitotic activity and evident spoptosis. The size of these fragments is much larger than that of usual colposcopic biopsies. The atypical glandular epithelia display features of both endocervical and endometrioid differentiation - consistent with Mullerian origin. Involvement by dysplastic glands is quite extensive. Although transition between dysplastic and benign glandular lining is readily seen and supports primary endocervical adenocarcinoma in situ (or invasive), this does not exclude the possibility of metastasis from uterine corpus (endometrium). A few mucin pools are seen, but it is difficult to be certain whether stromal invasion has occurred. Well differentiated invasive endocervical adenocarcinoma may appear very bland and not show any desmoplasia. The glandular architecture and their placement in relation to mucosal surface become important. I would interpret this difficult case as "endocervical mucosa containing markedly atypical glands consistent with extensive endocervical adenocarcinoma ih situ" and give a comment indicating that stromal invasion is suspected. The next logical thing to do is to do conization or LEEP, and the "pelvic mass known for 1+ year" should also be investigated to find out whether they are related. A difficult case this is!

abin译：

标本呈息肉状，由大片子宫颈粘膜组成，被不规则腺体累及，腺体有细胞学非典型性、明显核分裂活性和明显凋亡。这些大片组织明显比通常的活检标本大。非典型性腺上皮兼有宫颈管和内膜样分化的特征--这与苗勒氏起源一致。异型性腺体的累及非常广泛。尽管异型性腺体与良性腺体之间存在明显的移行过渡，支持原发性宫颈原位腺癌（或浸润），但不能排除来自宫体（内膜）的转移。 可见一些粘液池，但它难以确定是否已经发生间质浸润。高分化浸润性宫颈腺癌可以表现得非常温和善良并且没有任何促结缔组织反应。腺体的结构和它们取代粘膜表面的这种相互关系，对于判断变得非常重要。我对这个疑难病例的解释是“宫颈粘膜含有显著异型腺体，符合广泛性宫颈原位腺癌”并加评注指出怀疑间质浸润。 随后合理的处理应当是锥切或LEEP。并且“盆腔包块一年多”也应该进一步检查是否与此有关。这确实是一个困难病例！

译文（新手上路 请多指点）：

赞同以上各位的意见，此例可诊断为“宫颈内原位腺癌”。但是，由于宫颈内原位腺癌并不能表现为盆腔内肿块，所以必须提醒临床医生注意扩散到宫颈的腺癌（临床上通常不形成明显的宫颈肿块，而且仅从上传的这些照片中并没发现明显的浸润）和其他病变与此“宫颈内原位腺癌”共存。