HIgh magnification view showing trabecular growth, palisading of columnar cells along the periphery of the tumor nest at the left of the image, finely granular nuclear chromatin, non-prominent nucleoli and a single mitosis. This tumor contained between 2-10 mitoses/10 high power fields. The term atypical carcinoid may be somewhat misleading since it may give the impression of a low grade of malignancy when if fact these are fully malignant neoplasms in which distant metastases are present in about 20% of patients at presentation and the disease free survival after 10 years is about 50%. An alternate name - neuroendocrine carcinoma grade 2 - has been suggested. I believe that this is preferable to atypical carcinoid but others are unwilling to accept this terminology.