Case and Research Letters
Angiolymphoid Hyperplasia With Eosinophilia: Analysis of 7 Cases
Hiperplasia angiolinfoide con eosinofilia. Revisión de 7 casos
L. Padilla-España
, T. Fernández-Morano, J. del Boz, R. Fúnez-Liébana
Corresponding author
Servicio de Dermatología y Anatomía Patológica, Hospital Costa del Sol, Marbella, Málaga, Spain
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Padilla-España, T. Fernández-Morano, J. del Boz, R. Fúnez-Liébana" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Padilla-España" "email" => array:1 [ 0 => "eplaura85@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Fernández-Morano" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "del Boz" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Fúnez-Liébana" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología y Anatomía Patológica, Hospital Costa del Sol, Marbella, Málaga, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hiperplasia angiolinfoide con eosinofilia. Revisión de 7 casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1828 "Ancho" => 2500 "Tamanyo" => 877507 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histologic features of angiolymphoid hyperplasia. A, Hematoxylin-eosin, original magnification ×40. B, Hematoxylin-eosin, original magnification ×100. C, Hematoxylin-eosin, original magnification ×200. D, Dermoscopic image of angiolymphoid hyperplasia.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Angiolymphoid hyperplasia with eosinophilia (ALHE), also known as epithelioid hemangioma, is a chronic, benign vascular proliferation for which no cases of malignant transformation have been reported to date. Spontaneous resolution has been described in some patients,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> particularly in those with small lesions. ALHE is characterized by a high rate of recurrence (approximately 30%), regardless of treatment modality.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We describe the clinical and pathologic characteristics of 7 cases of ALHE diagnosed in our hospital between 2005 and 2011 (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Six of the patients were women; 5 of these were in their 40s and 1 was aged 75 years when the disease was diagnosed. The seventh patient was a 43-year-old man. The predominant clinical presentation was erythematous papules and plaques (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Subcutaneous masses were observed in 2 cases. In all 7 patients, the lesions were located on the head and neck, specifically in retroauricular areas, on the helix of the ear, on the nose, on the temple, in the posterior cervical region, and in the frontal region (2 cases). The most common treatment was surgical excision (5 cases). This produced a satisfactory clinical outcome, although recurrence was observed in 4 cases. Recurrent lesions were treated with cryotherapy, intralesional corticosteroid injections, and electrocoagulation, resulting in complete resolution in 1 case; the remaining lesions remained stable. Spontaneous involution following biopsy was observed in 1 patient with a single papular lesion on the nasal dorsum.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">None of the patients had peripheral eosinophilia, palpable lymph nodes, or a history of trauma in the area of the lesions. Dermoscopic evaluation of 1 of the lesions showed a lacunar pattern similar to the characteristic pattern seen in hemangiomas (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">ALHE is considered a rare entity, although it is also believed to be underdiagnosed because of its diverse clinical presentations. Histology, therefore, has a key diagnostic role in this disease. Characteristic findings include prominent epithelioid-like endothelial cells lining the vascular lumen and surrounded by a mixed, predominantly eosinophilic, inflammatory infiltrate (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The differential diagnosis is very wide, with Kimura disease generating the most controversy.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Until recently, ALHE and Kimura disease were considered to represent opposite ends of the same entity, but they are now considered to be separate diseases due to their clinical and histologic differences. Considering the large number of disorders in the differential diagnosis, biopsy of lesions is a key diagnostic tool in ALHE. There are many treatment options for ALHE, the most common of which are surgical excision, cryotherapy, and intralesional corticosteroids. Cryotherapy was used to treat papular lesions on the face of 1 of our patients, with favorable clinical and cosmetic results. Considering that it is fast and simple, this treatment modality is a viable option for superficial lesions. Electrocoagulation is also useful for superficial lesions, particularly when they are small. We achieved control of a lesion located on the edge of the helix of an elderly patient with intralesional corticosteroids, although the lesion did not resolve completely. The patient refused to undergo more invasive treatment. Surgical excision is perhaps the most viable therapeutic option for subcutaneous masses in ALHE.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Less common treatments described in the literature include laser therapy (considered the first-line alternative for superficial lesions), pentoxifylline, indomethacin, retinoids, chemotherapeutic agents (bleomycin, vinblastine, fluorouracil), levamisole, and interferon.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">As seen, many treatment options exist for ALHE, but there is no consensus on the treatment of choice due to the shortage of studies. Considering that ALHE is a benign condition that follows a chronic, recurrent course, perhaps the best option in the majority of cases is a conservative, watch-and-wait approach.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The largest series of ALHE cases identified in our review of the literature was one involving 116 patients (with a predominance of men) reported in 1985.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In Spain, the largest series published to date involved 5<span class="elsevierStyleSup">2</span>and 3<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> patients. In this second study, good results were achieved with vascular laser therapy.</p><p id="par0045" class="elsevierStylePara elsevierViewall">With 7 cases, ours is the largest series of ALHE to be published in Spain to date. We have performed a review of the literature on this entity and described the first—to our knowledge—dermoscopic analysis of an ALHE lesion.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Padilla-España L, et al. Hiperplasia angiolinfoide con eosinofilia. Revisión de 7 casos. Actas Dermosifiliogr. 2013;104:353–5.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1512 "Ancho" => 1667 "Tamanyo" => 327680 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Angiolymphoid hyperplasia lesion before treatment. B, Angiolymphoid hyperplasia lesion after treatment with intralesional corticosteroids. C, Original retroauricular angiolymphoid hyperplasia lesion. D, Angiolymphoid hyperplasia lesion that recurred after surgery.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1828 "Ancho" => 2500 "Tamanyo" => 877507 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histologic features of angiolymphoid hyperplasia. A, Hematoxylin-eosin, original magnification ×40. B, Hematoxylin-eosin, original magnification ×100. C, Hematoxylin-eosin, original magnification ×200. D, Dermoscopic image of angiolymphoid hyperplasia.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: F, female; M, male.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Age, y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Clinical Presentation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Lesion Site \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Recurrence \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reddish papules \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Temple \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SurgeryCryotherapyElectrocoagulation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reddish papules \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retroauricular area \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Violaceous tumor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ear \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Corticosteroids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reddish tumor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neck \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Subcutaneous mass \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Forehead \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SurgeryCorticosteroids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Subcutaneous mass \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Forehead \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SurgeryCorticosteroids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Reddish papule \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spontaneous involution \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab185621.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Review of 7 Cases of Angiolymphoid Hyperplasia With Eosinophilia Treated at our Hospital Between 2005 and 2011.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hiperplasia angiolinfoide con eosinofilia" "autores" => array:1 [ 0 => array:2 [ "etal" => 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 16 | 9 | 25 |
| 2024 October | 107 | 51 | 158 |
| 2024 September | 95 | 24 | 119 |
| 2024 August | 118 | 71 | 189 |
| 2024 July | 91 | 42 | 133 |
| 2024 June | 101 | 44 | 145 |
| 2024 May | 111 | 35 | 146 |
| 2024 April | 84 | 28 | 112 |
| 2024 March | 102 | 37 | 139 |
| 2024 February | 88 | 39 | 127 |
| 2024 January | 104 | 37 | 141 |
| 2023 December | 112 | 26 | 138 |
| 2023 November | 115 | 25 | 140 |
| 2023 October | 107 | 32 | 139 |
| 2023 September | 129 | 38 | 167 |
| 2023 August | 94 | 23 | 117 |
| 2023 July | 128 | 38 | 166 |
| 2023 June | 109 | 21 | 130 |
| 2023 May | 123 | 39 | 162 |
| 2023 April | 170 | 41 | 211 |
| 2023 March | 75 | 32 | 107 |
| 2023 February | 133 | 34 | 167 |
| 2023 January | 173 | 35 | 208 |
| 2022 December | 118 | 42 | 160 |
| 2022 November | 77 | 37 | 114 |
| 2022 October | 93 | 26 | 119 |
| 2022 September | 100 | 41 | 141 |
| 2022 August | 51 | 37 | 88 |
| 2022 July | 72 | 47 | 119 |
| 2022 June | 31 | 26 | 57 |
| 2022 May | 94 | 51 | 145 |
| 2022 April | 95 | 38 | 133 |
| 2022 March | 64 | 59 | 123 |
| 2022 February | 70 | 33 | 103 |
| 2022 January | 86 | 38 | 124 |
| 2021 December | 60 | 41 | 101 |
| 2021 November | 78 | 54 | 132 |
| 2021 October | 70 | 66 | 136 |
| 2021 September | 75 | 60 | 135 |
| 2021 August | 114 | 36 | 150 |
| 2021 July | 76 | 40 | 116 |
| 2021 June | 58 | 41 | 99 |
| 2021 May | 47 | 46 | 93 |
| 2021 April | 140 | 33 | 173 |
| 2021 March | 94 | 37 | 131 |
| 2021 February | 44 | 32 | 76 |
| 2021 January | 42 | 18 | 60 |
| 2020 December | 32 | 26 | 58 |
| 2020 November | 30 | 16 | 46 |
| 2020 October | 23 | 12 | 35 |
| 2020 September | 26 | 12 | 38 |
| 2020 August | 27 | 17 | 44 |
| 2020 July | 20 | 15 | 35 |
| 2020 June | 32 | 18 | 50 |
| 2020 May | 22 | 15 | 37 |
| 2020 April | 29 | 19 | 48 |
| 2020 March | 34 | 22 | 56 |
| 2020 February | 4 | 9 | 13 |
| 2020 January | 8 | 9 | 17 |
| 2019 December | 8 | 6 | 14 |
| 2019 November | 4 | 1 | 5 |
| 2019 October | 0 | 2 | 2 |
| 2019 September | 6 | 12 | 18 |
| 2019 August | 4 | 7 | 11 |
| 2019 July | 4 | 25 | 29 |
| 2019 June | 4 | 16 | 20 |
| 2019 May | 6 | 5 | 11 |
| 2019 April | 2 | 15 | 17 |
| 2019 March | 2 | 11 | 13 |
| 2019 February | 2 | 5 | 7 |
| 2019 January | 4 | 6 | 10 |
| 2018 December | 0 | 9 | 9 |
| 2018 November | 1 | 0 | 1 |
| 2018 October | 6 | 0 | 6 |
| 2018 September | 3 | 0 | 3 |
| 2018 August | 0 | 5 | 5 |
| 2018 June | 0 | 1 | 1 |
| 2018 May | 0 | 5 | 5 |
| 2018 April | 0 | 4 | 4 |
| 2018 March | 1 | 0 | 1 |
| 2018 February | 61 | 4 | 65 |
| 2018 January | 50 | 6 | 56 |
| 2017 December | 40 | 4 | 44 |
| 2017 November | 44 | 5 | 49 |
| 2017 October | 44 | 4 | 48 |
| 2017 September | 53 | 5 | 58 |
| 2017 August | 42 | 9 | 51 |
| 2017 July | 32 | 10 | 42 |
| 2017 June | 48 | 16 | 64 |
| 2017 May | 43 | 10 | 53 |
| 2017 April | 36 | 17 | 53 |
| 2017 March | 24 | 36 | 60 |
| 2017 February | 28 | 10 | 38 |
| 2017 January | 53 | 13 | 66 |
| 2016 December | 77 | 12 | 89 |
| 2016 November | 130 | 30 | 160 |
| 2016 October | 111 | 9 | 120 |
| 2016 September | 166 | 18 | 184 |
| 2016 August | 147 | 8 | 155 |
| 2016 July | 50 | 9 | 59 |
| 2016 June | 6 | 8 | 14 |
| 2016 May | 5 | 10 | 15 |
| 2016 April | 5 | 1 | 6 |
| 2016 March | 1 | 10 | 11 |
| 2016 February | 13 | 1 | 14 |
| 2016 January | 8 | 2 | 10 |
| 2015 December | 9 | 1 | 10 |
| 2015 November | 23 | 3 | 26 |
| 2015 October | 8 | 3 | 11 |
| 2015 September | 16 | 1 | 17 |
| 2015 August | 22 | 4 | 26 |
| 2015 July | 96 | 116 | 212 |
| 2015 June | 93 | 10 | 103 |
| 2015 May | 89 | 17 | 106 |
| 2015 April | 28 | 1 | 29 |
| 2015 March | 22 | 3 | 25 |
| 2015 February | 30 | 5 | 35 |
| 2015 January | 48 | 1 | 49 |
| 2014 December | 54 | 5 | 59 |
| 2014 November | 42 | 1 | 43 |
| 2014 October | 78 | 1 | 79 |
| 2014 September | 63 | 5 | 68 |
| 2014 August | 57 | 1 | 58 |
| 2014 July | 59 | 4 | 63 |
| 2014 June | 80 | 7 | 87 |
| 2014 May | 67 | 10 | 77 |
| 2014 April | 52 | 7 | 59 |
| 2014 March | 54 | 8 | 62 |
| 2014 February | 34 | 9 | 43 |
| 2014 January | 44 | 4 | 48 |
| 2013 December | 43 | 9 | 52 |
| 2013 November | 27 | 5 | 32 |
| 2013 October | 25 | 8 | 33 |
| 2013 September | 14 | 10 | 24 |
| 2013 August | 10 | 22 | 32 |
| 2013 July | 13 | 14 | 27 |
| 2013 June | 0 | 3 | 3 |
| 2013 May | 9 | 13 | 22 |
Show all
