The presence of malignant tumor cells in a vaginal and cervical smear of a 53-year-old female with vaginal bleeding and with subsequent negative histology of the scraping material could be later correlated with a leiomyosarcoma of the myometrium that produced deep local invasion and pulmonary metastases. The findings that favor the cytologic diagnosis of this neoplasm are the presence of isolated cells or the side-by-side arrangement of the tumor cells, the elongated shape of the cytoplasm, and the ovoidal cigar-shaped nuclei with sparse, coarse chromocenters. Cytologic differential diagnosis of other malignant neoplasms capable of cellular exfoliation into the vagina is discussed.
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