Carcinoids are rare, slow growing tumors that arise from neuroendocrine cells which involve many organs and most frequently the gastrointestinal (GI) tract. Common morphology and patterns are solid nests, trabecular, tubular, atypical or poorly differentiated and mixed. Clear cell types have been described without atypia. The objective of this report is to present an unusual multifocal carcinoid tumor with atypia and clear cell changes. The patient was a 75 year old hypertensive male with anemia due to blood loss secondary to lower gastrointestinal bleeding from the polyps, which was not usual for carcinoid tumors. The differential diagnosis included poorly differentiated adenocarcinoma, paraganglioma including the gangliocytic type, metastatic clear cell tumors aside from the adenocarcinoids and clear cell carcinoids. The clinical presentation of GI bleeding and histologic pattern mimicked closely that of paraganglioma. The diagnosis of atypical carcinoid with clear cell features was achieved using mucicarmine and PAS stain and immunostains using cytokeratin, NSE and chromogranin. Co-morbid conditions in this patient such as hypertension and intestinal irritation due to bleeding were believed to mask the symptoms of a possible carcinoid syndrome.