Case for diagnosis
Linear Exophytic Tumor on the Dorsum of the Tongue
Tumoración exofítica y lineal en el dorso de la lengua
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Meseguer-Yebra, S. Córdoba-Guijarro, J. Borbujo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Meseguer-Yebra" "email" => array:1 [ 0 => "camesye@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "S." "apellidos" => "Córdoba-Guijarro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Borbujo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Sección de Dermatología, Complejo Asistencial de Zamora, Zamora, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tumoración exofítica y lineal en el dorso de la lengua" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1547 "Ancho" => 1333 "Tamanyo" => 241717 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Appearance of the lesion after 1 month of treatment with topical antifungal agents and a reduction in smoking.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was a 68-year-old man who presented with a 10-year history of a growth on the dorsum of the tongue. The lesion was asymptomatic, had not been previously treated, and had grown slowly and progressively. The patient had no relevant past medical history, smoked 20 cigarettes a day, used a dental prosthesis that he removed at night, and was undergoing treatment with nystatin mouthwashes (after meals) and omeprazole (20<span class="elsevierStyleHsp" style=""></span>mg/d).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">Examination revealed a coated tongue, and along the dorsal midline a pinkish, lobulated plaque with a shiny surface and rubbery consistency (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). No lymphadenopathies were detected on palpation of the craniocervical region.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Additional tests</span><p id="par0015" class="elsevierStylePara elsevierViewall">The following tests were performed: punch biopsy; culture in Sabouraud's medium, which was positive for <span class="elsevierStyleItalic">Candida albicans</span>; and routine blood tests, which were normal, including negative HIV serology.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Histology</span><p id="par0020" class="elsevierStylePara elsevierViewall">On histology, the mucosa exhibited marked acanthosis and papillomatosis, as well as an increase in the mitotic activity of the basal layer, with no alterations in cell polarity or maturation. A moderate lymphohistiocytic interstitial infiltrate and vascular ectasia were observed in the chorion (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Periodic acid Schiff (PAS) and PAS diastase staining revealed no fungal structures.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">What Is Your Diagnosis?</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Hypertrophic median rhomboid glossitis (MRG).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Course</span><p id="par0035" class="elsevierStylePara elsevierViewall">Quitting smoking was recommended, and this resulted in a significant improvement and a decrease in the size of the lesion (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The patient was subsequently treated with fluconazole (50 mg/12 h by mouth) for 14 days, which led to some additional improvement. Despite continued systemic antifungal treatment and replacement of the patient's dental prosthesis, subsequent cultures were only transiently negative. The patient was thus referred to the otolaryngology service for carbon-dioxide laser treatment of the residual lesion, which resulted in complete resolution of the plaque with no recurrences after more than a year of follow-up.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">MRG is uncommon and probably underdiagnosed, and for many years was considered to be a malformation.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It manifests as a clearly defined, rhomboid-shaped, atrophic or globular erythematous plaque, which appears on the midline of the dorsum of the tongue. It most commonly affects men, smokers, and diabetics, and the response to antifungal therapy is variable. Several hypotheses have been proposed to explain why the infection in MRG manifests in such a localized manner. According to Whitaker and coworkers,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> the affected region lies on the hard palate during deglutition, phonation, and rest, thus reducing its exposure to the the action of the saliva. Other authors propose that blood flow in this region is reduced compared with the rest of the tongue. In some cases an opposing erythematous plaque, or “kissing lesion”, is observed on the hard palate; according to Brown and colleagues,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> this may be a marker of associated immunosuppression.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Diagnosis is clinical, supported by a positive culture. The most commonly isolated species is <span class="elsevierStyleItalic">Candida albicans</span>, followed by <span class="elsevierStyleItalic">Candida glabrata</span>, <span class="elsevierStyleItalic">Candida tropicalis</span>, and <span class="elsevierStyleItalic">Candida parapsilosis</span>, although up to 10% of samples can contain 2 or more <span class="elsevierStyleItalic">Candida</span> species.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In some cases a biopsy may be required to rule out neoplasia. PAS staining can be negative in up to 13% of cases, as <span class="elsevierStyleItalic">Candida</span> does not invade the epithelium and is lost during sample processing. The principal differential diagnosis is with squamous cell carcinoma and Abrikossoff tumor.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Barret and coworkers<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> observed a statistically significant association between moderate-severe epithelial dysplasia and the presence of fungi on staining with PAS; they therefore recommend screening with this staining method in this type of lesion. However, those authors were unable to state whether <span class="elsevierStyleItalic">Candida</span> exerts a pathogenic effect in these cases or merely colonizes previously altered tissue.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Treatment is usually topical, associated with the correction of predisposing factors; combined topical and oral therapy is reserved for highly recurrent infections or immunosuppressed patients. Surgical treatment may be useful in cases of persistent exophytic lesions, for which medical treatments are of limited effectiveness.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Additional tests" ] 3 => array:3 [ "identificador" => "sec0020" "titulo" => "Histology" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical Course" ] ] ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of Interest" ] 6 => array:2 [ "identificador" => "xack49989" "titulo" => "Acknowledgements" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Meseguer-Yebra C, et al. Tumoración exofítica y lineal en el dorso de la lengua. Actas Dermosi-filiogr. 2013;104:435-6.</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" => 1224 "Ancho" => 1333 "Tamanyo" => 265012 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lobulated, elastic, pink-colored lesion on the midline of the dorsum of the tongue.</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" => 1267 "Ancho" => 1583 "Tamanyo" => 736149 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×4.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1547 "Ancho" => 1333 "Tamanyo" => 241717 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Appearance of the lesion after 1 month of treatment with topical antifungal agents and a reduction in smoking.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Median rhomboid glossitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.L. 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Singh" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Oral Surg Oral Med Oral Pathol Oral Radiol Endon" "fecha" => "1996" "volumen" => "81" "paginaInicial" => "379" "paginaFinal" => "380" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Median rhomboid glossitis and a “kissing” lesion of the palate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.S. Brown" 1 => "A.M. Kradow" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Oral Surg Oral Med Oral Pathol" "fecha" => "1996" "volumen" => "82" "paginaInicial" => "472" "paginaFinal" => "473" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Candidiasis orales" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.M. Aguirre Urizar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Iberoam Micol" "fecha" => "2002" "volumen" => "19" "paginaInicial" => "17" "paginaFinal" => "21" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12716225" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rhomboid glossitis in atypical location: case report and differential diagnosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Lago-Méndez" 1 => "A. Blanco-Carrión" 2 => "M. Diniz-Freitas" 3 => "P. Gándara-Vila" 4 => "A. García-García" 5 => "J.M. Gándara-Rey" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Oral Patol Oral Cir Bucal" "fecha" => "2005" "volumen" => "10" "paginaInicial" => "123" "paginaFinal" => "127" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15735544" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The frequency of fungal infection in biopsies of oral mucosal lesions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.W. Barrett" 1 => "V.J. Kingsmill" 2 => "P.M. Speight" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Oral Dis" "fecha" => "1998" "volumen" => "4" "paginaInicial" => "26" "paginaFinal" => "31" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9655041" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack49989" "titulo" => "Acknowledgements" "texto" => "<p id="par0060" class="elsevierStylePara elsevierViewall">We would like to thank Dr. Ángel Castaño Pascual of the Pathology Department of Hospital Universitario de Fuenlabrada for his help with the histological study in this case.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000005/v1_201307051101/S157821901300098X/v1_201307051101/en/main.assets" "Apartado" => array:4 [ "identificador" => "6154" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010400000005/v1_201307051101/S157821901300098X/v1_201307051101/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901300098X?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 13 | 16 | 29 |
| 2024 October | 94 | 44 | 138 |
| 2024 September | 85 | 39 | 124 |
| 2024 August | 144 | 81 | 225 |
| 2024 July | 145 | 58 | 203 |
| 2024 June | 139 | 72 | 211 |
| 2024 May | 87 | 58 | 145 |
| 2024 April | 90 | 55 | 145 |
| 2024 March | 67 | 53 | 120 |
| 2024 February | 83 | 39 | 122 |
| 2024 January | 82 | 49 | 131 |
| 2023 December | 82 | 63 | 145 |
| 2023 November | 157 | 51 | 208 |
| 2023 October | 146 | 55 | 201 |
| 2023 September | 129 | 61 | 190 |
| 2023 August | 86 | 34 | 120 |
| 2023 July | 133 | 58 | 191 |
| 2023 June | 98 | 46 | 144 |
| 2023 May | 150 | 46 | 196 |
| 2023 April | 99 | 35 | 134 |
| 2023 March | 107 | 39 | 146 |
| 2023 February | 87 | 32 | 119 |
| 2023 January | 94 | 39 | 133 |
| 2022 December | 84 | 48 | 132 |
| 2022 November | 55 | 43 | 98 |
| 2022 October | 61 | 30 | 91 |
| 2022 September | 55 | 49 | 104 |
| 2022 August | 50 | 47 | 97 |
| 2022 July | 34 | 50 | 84 |
| 2022 June | 41 | 33 | 74 |
| 2022 May | 90 | 46 | 136 |
| 2022 April | 127 | 51 | 178 |
| 2022 March | 105 | 64 | 169 |
| 2022 February | 88 | 30 | 118 |
| 2022 January | 126 | 51 | 177 |
| 2021 December | 78 | 56 | 134 |
| 2021 November | 91 | 55 | 146 |
| 2021 October | 93 | 70 | 163 |
| 2021 September | 82 | 45 | 127 |
| 2021 August | 105 | 40 | 145 |
| 2021 July | 84 | 50 | 134 |
| 2021 June | 46 | 39 | 85 |
| 2021 May | 53 | 47 | 100 |
| 2021 April | 185 | 98 | 283 |
| 2021 March | 97 | 42 | 139 |
| 2021 February | 102 | 32 | 134 |
| 2021 January | 52 | 40 | 92 |
| 2020 December | 46 | 29 | 75 |
| 2020 November | 53 | 28 | 81 |
| 2020 October | 53 | 25 | 78 |
| 2020 September | 40 | 16 | 56 |
| 2020 August | 32 | 27 | 59 |
| 2020 July | 34 | 22 | 56 |
| 2020 June | 47 | 30 | 77 |
| 2020 May | 27 | 42 | 69 |
| 2020 April | 36 | 26 | 62 |
| 2020 March | 41 | 29 | 70 |
| 2020 February | 6 | 23 | 29 |
| 2020 January | 4 | 19 | 23 |
| 2019 December | 8 | 34 | 42 |
| 2019 November | 8 | 10 | 18 |
| 2019 October | 0 | 11 | 11 |
| 2019 September | 4 | 17 | 21 |
| 2019 August | 8 | 8 | 16 |
| 2019 July | 8 | 30 | 38 |
| 2019 June | 10 | 21 | 31 |
| 2019 May | 8 | 63 | 71 |
| 2019 April | 4 | 32 | 36 |
| 2019 March | 5 | 19 | 24 |
| 2019 February | 2 | 4 | 6 |
| 2019 January | 6 | 9 | 15 |
| 2018 December | 1 | 7 | 8 |
| 2018 November | 3 | 2 | 5 |
| 2018 October | 6 | 0 | 6 |
| 2018 September | 1 | 0 | 1 |
| 2018 March | 20 | 2 | 22 |
| 2018 February | 83 | 4 | 87 |
| 2018 January | 139 | 5 | 144 |
| 2017 December | 83 | 7 | 90 |
| 2017 November | 83 | 6 | 89 |
| 2017 October | 90 | 3 | 93 |
| 2017 September | 78 | 1 | 79 |
| 2017 August | 119 | 10 | 129 |
| 2017 July | 103 | 5 | 108 |
| 2017 June | 134 | 26 | 160 |
| 2017 May | 93 | 16 | 109 |
| 2017 April | 73 | 10 | 83 |
| 2017 March | 53 | 8 | 61 |
| 2017 February | 143 | 8 | 151 |
| 2017 January | 86 | 9 | 95 |
| 2016 December | 108 | 8 | 116 |
| 2016 November | 153 | 10 | 163 |
| 2016 October | 169 | 8 | 177 |
| 2016 September | 229 | 14 | 243 |
| 2016 August | 240 | 9 | 249 |
| 2016 July | 96 | 3 | 99 |
| 2016 June | 6 | 10 | 16 |
| 2016 May | 10 | 11 | 21 |
| 2016 April | 4 | 3 | 7 |
| 2016 March | 5 | 0 | 5 |
| 2016 February | 4 | 4 | 8 |
| 2016 January | 9 | 2 | 11 |
| 2015 December | 7 | 2 | 9 |
| 2015 November | 36 | 4 | 40 |
| 2015 October | 10 | 4 | 14 |
| 2015 September | 15 | 3 | 18 |
| 2015 August | 10 | 1 | 11 |
| 2015 July | 162 | 5 | 167 |
| 2015 June | 112 | 15 | 127 |
| 2015 May | 73 | 15 | 88 |
| 2015 April | 57 | 6 | 63 |
| 2015 March | 74 | 2 | 76 |
| 2015 February | 104 | 3 | 107 |
| 2015 January | 38 | 5 | 43 |
| 2014 December | 50 | 5 | 55 |
| 2014 November | 63 | 6 | 69 |
| 2014 October | 59 | 7 | 66 |
| 2014 September | 64 | 3 | 67 |
| 2014 August | 55 | 9 | 64 |
| 2014 July | 56 | 8 | 64 |
| 2014 June | 55 | 6 | 61 |
| 2014 May | 60 | 7 | 67 |
| 2014 April | 51 | 5 | 56 |
| 2014 March | 58 | 10 | 68 |
| 2014 February | 52 | 7 | 59 |
| 2014 January | 38 | 8 | 46 |
| 2013 December | 54 | 6 | 60 |
| 2013 November | 21 | 5 | 26 |
| 2013 October | 31 | 2 | 33 |
| 2013 September | 24 | 2 | 26 |
| 2013 August | 41 | 5 | 46 |
| 2013 July | 26 | 5 | 31 |
| 2013 June | 8 | 2 | 10 |
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