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The microscopic features of atypical carcinoid are similar to those of typical carcinoids. In addition, necrosis and/or increased mitotic activity (2-10 or more mitoses/HPF) are present by definition. Nuclear pleomorphism, diffuse sheet-like areas, and calcification are more commonly seen than typical carcinoids. Even small punctate areas of necrosis are enough to justify the designation of atypical carcinoid.

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