Spread to hilar and mediastinal lymph nodes is seen in 5% of typical carcinoids and in almost 70% of atypical carcinoids of the lung. Distant metastases to liver and bones also may occur, more frequently with atypical carcinoids. The skeletal metastases are osteoblastic type. This image shows typical pulmonary carcinoid metastasizing to hilar lymph nodes. The tumor is on the upper left and the lymphoid tissue on the lower right. Note the anthracotic pigment.