Type of Preparation: Conventional Magnification: Medium Clinical History: Postmenopausal woman undergoing radiation Interpretation: NILM: Rectovaginal fistula Cytomorphologic Criteria: Benign glandular cells, tall columnar, and plaque of hyperkeratosis. Explanatory Notes: While at first glance he glandular cells may appear to be endocervical, closer examination shows goblet cell features. Fecal matter may also be seen in an RV fistula (not demonstrated here) and is an additional clue to its presence. The hyperkeratosis indicates a benign cellular change, in this case secondary to the fistula. Follow-up: Recto-vaginal (RV) diagnosed after call made to clinician based on Pap smear findings