Type of Preparation: Conventional Magnification: High Clinical History: 64 year old postmenopausal woman with extensive Paget disease of vulva that appears to extend into the vagina Interpretation: Other Malignant Neoplasms: Paget disease Cytomorphologic Criteria: The vaginal smear has loosely cohesive groups and single cells with pleomorphic hyperchromatic nuclei, irregular clumped chromatin, prominent nucleoli, and moderate amounts of cytoplasm. A cytoplasmic vacuole within the binucleated cell is suggestive of glandular differentiation. Explanatory Notes: The cytologic features, although diagnostic of malignancy and consistent with adenocarcinoma, are not specific for Paget disease. History and comparison with primary tumor support that interpretation. Follow-up: Compared with prior tissue