The smear shows abnormal squamous cells in a hypotrophic postmenopausal pattern. There are groups of spindle shaped parabasal cells. Some small hyperkeratotic cells are also present. There is one cell with a bizarre shape but with a nucleus with normal looking chromatin. Clean background with very few inflammatory cells or debris. These findings suggested the diagnosis of ASC-H in a hypotrophic smear. The clinician ordered a colposcopy, that revealed only an atrophic cervix, and a Hybrid Capture 2 test, that was negative for HPV DNA. This management is still controversial: read the abstracts on ASC-US and ASC-H management. A follow up smear taken one year later was entirely normal.