Discussion: While it is true that parabasal atrophy is present the glandular cells described above are the important finding. ASC-H and HSIL are in the differential of small hyperchromatic groups, but closer inspection in this case confirms glandular not squamous origin. The morphology in this case is consistent with endometrial origin. Endometrial cells must always be reported in women over 40. In younger women the decision to report endometrial type cells is based on the morphology of the cells and the menstrual history. In this case the patient was post-menopausal and experiencing vaginal bleeding. Follow-up endometrial curretage revealed well-differentiated (FIGO grade 1) endometrial carcinoma.

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Cytopathology: Several glandular fragments are identified. The glandular cells are small and form 3-dimensional structures. The cells are relatively well preserved and some of the cells appear to have neutrophils present in the cytoplasm. The background squamous cells show atrophic changes.