A Pap test from a 55-year-old woman who previously had a hysterectomy for ovarian cancer was diagnosed as low-grade squamous intraepithelial lesion (LGSIL). LGSIL is characterized by cells with nuclei 3-4 times the size of normal cells and the presence of koilocytes indicating human papillomavirus infection. While most LGSIL regress on their own, follow up with colposcopy and biopsy is recommended as 20-30% of such cases may harbor a high-grade lesion in the cervical canal.