Direct sampling of the lower uterine segment endometrium (LUS) may mimic atypical glandular lesions or resemble the cells of high grade squamous intraepithelial lesion. This study was done to further characterize the cytologic features of LUS and to determine the incidence of these cells in patients who have previously undergone cone biopsies. Cervical smears from 64 patients who had had a previous cervical cone biopsy were reviewed and compared to pre-cone cervical smears and any post-cone cervical biopsies or endocervical curettage specimens. Twelve smears from 63 patients (19%) were found to have fragments of LUS. Cytologic features of LUS included large groups with gland openings, branched glands, and nuclear palisading within the fragments. The fragments often were accompanied by endometrial stroma. Smaller fragments were frequently encountered. These were densely cellular but contained nuclear palisading.