Small cell carcinoma of the lung has usually metastasized by the time of diagnosis. Local spread to intrathoracic and supraclavicular lymph nodes is common. Distant sites of metastases include liver, bone, brain, contralateral lung, and adrenal glands. The patient may also develop malignant pleural and pericardial effusions. The image shows nuclear detail at high magnification. The cells are small with hyperchromatic nuclei and scant cytoplasm.