Which usual histologic criteria for malignancy do not apply to papillary carcinoma?

The long term complications of diabetes affect blood vessels of all sizes: accelerated atherosclerosis (macroangiopathy) affecting all of the usual sites: aorta, carotids, peripheral arteries, coronaries, etc. Microangiopathy, or small vessel disease, affects capillaries throughout the body, but rather important clinical effects are seen in the kidney and eyes. In addition there is neuropathy. This patient at the time of second admission had coronary atherosclerosis (rare in a 37 year old non-diabetic female) with myocardial infarction, and renal disease resulting from microangiopathy affecting the glomeruli.

The patient also had retinal microangiopathy. The other vascular complication not seen in this patient is peripheral vascular disease. Diabetics have a 100-fold increase in atherosclerotic narrowing of medium sized arteries such as femoral and popliteal, and attendant increase in gangrene.

These patients are also more susceptible to infections, and infections increase insulin ... more.

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