A 40 year-old-man presented with complaints of vertigo and earache for the last 1 month. A lumbar puncture was done, and cerebrospinal fluid (CSF) was sent for cytological analysis. The cerebrospinal fluid (CSF) was centrifuged and smears were prepared and stained with May-Grünwald-Giemsa and Papanicolaou. The cytospin smears were cellular and showed inflammatory cells predominantly comprising polymorphs with few lymphocytes and monocytes. A few scattered large atypical cells were identified (Figure 1A-D). The cells were round in shape with orangeophilic cytoplasm in Papanicolaou stain. The nuclei were enlarged, hyperchromatic, and moderately pleomorphic.