高级别上皮内瘤变

 High grade intraepithelial neoplasia?  Sounds like terminology used in lower GYN tract.  We use mild/low grade or severe/high grade dysplasia in GI.  Moderate dysplasia is no longer in use in GI system.

Glands are haphazardly arranged (in contrary to the test tube like architecture seen in normal cononic mucosa) and no goblet cells are seen, but cells appear to be uniform.  I don't have a dianosis but have some thoughts: well differentiated adenocarcinoma? endometriosis? adenoma is also possibe but for a problem for >20 years history, i have to be very careful.

谢谢各位的高见，非常有道理，尤其mingfuyu 老师使我的思路扩展了不少。

我的意见是管状腺瘤伴腺体中-重度非典型增生，因取材浅表，未见明显蒂部浸润，不排除浸润癌可能，建议送完整息肉检查。

第二次送带基底的息肉病检，异性腺体已经浸润肌层了，故诊断高分化腺癌。