The overall prognosis of atypical carcinoids is slightly worse than that of carcinoids with survival rates reported between 20% and 70%. About 50% of patients have already developed metastases to regional lymph nodes by the time they present. Invasion of adjacent organs, pleural cavity, and pericardial cavity is also frequently seen. The sites of distant metastases include brain, lungs, spine, bones, liver, kidney, adrenals, and skin. This image of an atypical carcinoid shows spindle cell morphology and several mitotic figures.