CASE AND RESEARCH LETTER
Dermatomyofibroma on the Nape of the Neck: A Report of 2 Pediatric Cases
Dermatomiofibroma en la nuca: descripción de 2 casos en la edad pediátrica
a Servicio de Dermatología, Corporación Sanitaria Parc Taulí, Hospital Universitario Parc Taulí, Universidad Autónoma de Barcelona, Barcelona, Spain
b Servicio de Anatomía Patológica, Corporación Sanitaria Parc Taulí, Hospital Universitario Parc Taulí, Universidad Autónoma de Barcelona, Barcelona, Spain
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Romaní, L. Leal, A. Sáez, J. Luelmo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Romaní" "email" => array:1 [ 0 => "jromani@tauli.cat" ] "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" => "L." "apellidos" => "Leal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Sáez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Luelmo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Corporación Sanitaria Parc Taulí, Hospital Universitario Parc Taulí, Universidad Autónoma de Barcelona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Corporación Sanitaria Parc Taulí, Hospital Universitario Parc Taulí, Universidad Autónoma de Barcelona, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatomiofibroma en la nuca: descripción de 2 casos en la edad pediátrica" ] ] "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" => 851 "Ancho" => 1301 "Tamanyo" => 209688 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathology image of the tumor. A, at low magnification (original magnification, ×<span class="elsevierStyleHsp" style=""></span>20) and B, a high magnification (original magnification, ×<span class="elsevierStyleHsp" style=""></span>200) (hematoxylin-eosin).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Dermatomyofibroma is a rare benign tumor of myofibroblastic origin that was initially called plaque fibromatosis in the literature.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is most common in young women, but has occasionally been described in pediatric patients. A recently published review gathered a total of 34 cases in children.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> We present 2 pediatric cases (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, A and B) recently diagnosed and treated in our hospital. These cases support the benign nature of the lesion and the tendency of the tumor to arise on the neck.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The first patient was a 5-year-old boy with no past medical history of interest. He was referred to the dermatologist for evaluation of a tumor on the neck (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A) that his parents had noticed approximately 6 months earlier. There was no reported history of trauma. This asymptomatic lesion was palpable more than visible and it had a maximum diameter of 0.6<span class="elsevierStyleHsp" style=""></span>cm.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A punch biopsy taken from the center of the lesion revealed epidermal hyperplasia with mild hyperpigmentation of the basal layer. The full thickness of the dermis was affected by a proliferation of spindle-shaped cells in a fascicular arrangement, with their axes mainly oriented parallel to the epidermis; the lesion was paucicellular, and no cellular atypia or mitotic figures were observed. The spindle cells had slightly wavy nuclei (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>, A and B). No hyaline globules were observed in the cell cytoplasm. Immunohistochemistry was negative for protein s100, smooth muscle actin, muscle specific actin, desmin, Caldesmon, and CD34. Complete excision of the lesion was then performed and histology study reported identical findings.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The second patient was a 13-year-old boy with no relevant past medical history. He was referred to dermatology for investigation of an asymptomatic erythematous nodule on the neck with a maximum diameter of 1<span class="elsevierStyleHsp" style=""></span>cm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). The lesion had been present for at least 2 years. No history of trauma to the area was reported.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Punch biopsy and subsequent complete excision revealed an epidermis and superficial and mid dermis with no significant alterations, and a proliferation of spindle-shaped cells in the reticular dermis and most superficial part of the subcutaneous cellular tissue. This proliferation, which was paucicellular and showed no cellular atypia, formed bundles running parallel to the epidermis. The lesion presented noninfiltrative growth, surrounding but not eliminating the skin adnexa. Immunohistochemistry showed the cells to be negative for s100, smooth muscle actin, muscle specific actin, desmin, bcl-2, CD34, and CD99. The histology findings were identical to those of the previous case, shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>, A and B.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Both patients were followed up for 2 years after excision of the tumors and no recurrences were observed.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Dermatomiofibroma is a rare tumor in the pediatric age range. The first description of this tumor was published by Hügel<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in 1991. It was initially called plaque fibromatosis. The name dermatomyofibroma was proposed by Kamino<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> in 1992. The largest global series was gathered by Mentzel et al.,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> with a total of 56 patients aged between 3 and 51 years, and there was a female predominance. The main characteristic of the tumor is a proliferation of spindle cells oriented parallel to the surface of the epidermis. Ultrastructural studies and immunophenotyping have shown these cells to be fibroblasts and myofibroblasts. The immunohistochemical profile is very variable, although vimentin is frequently expressed. CD34 expression has been reported in some cases; this can complicate the diagnosis as dermatofibrosarcoma protuberans must then be considered in the differential diagnosis. Immunohistochemistry is useful to orient the pathologist, but the diagnosis is fundamentally morphological. Treatment is surgical, and recurrence is rare after excision with an adequate margin.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Tardío et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> gathered a total of 34 cases in children and 56% of those tumors were found on the neck, as in the 2 patients we describe. A primary characteristic of pediatric dermatomyofibroma therefore appears to be its tendency to arise in the cervical region. In adults, on the other hand, the tumor arises most frequently on the shoulders or proximal region of the limbs and is less common on the neck. The second characteristic is that the tumor predominantly affects boys. In adults, 90% of cases are in women.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–8</span></a> It has been speculated that the tumor may spontaneously regress in male children at puberty and persist in girls, leading to a higher prevalence in adult women.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The importance of this disease is its differentiation from other tumors formed of spindle cells, such as desmoid tumor and dermatofibrosarcoma protuberans. In addition, other mesenchymal lesions more typical of the pediatric age range, such as fibrous hamartoma of infancy, myofibromatosis, connective tissue nevus, and smooth muscle hamartoma, must be excluded. A guide to the differential diagnosis of these tumors is presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Romaní J, Leal L, Sáez A, Luelmo J. Dermatomiofibroma en la nuca: descripción de 2 casos en la edad pediátrica. Actas Dermosifiliogr. 2014 105:315–317.</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" => 1438 "Ancho" => 901 "Tamanyo" => 153622 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical image of the tumors on the neck of patient 1 (A) and of patient 2 (B).</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" => 851 "Ancho" => 1301 "Tamanyo" => 209688 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathology image of the tumor. A, at low magnification (original magnification, ×<span class="elsevierStyleHsp" style=""></span>20) and B, a high magnification (original magnification, ×<span class="elsevierStyleHsp" style=""></span>200) (hematoxylin-eosin).</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "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">Morphology \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">Immunohistochemistry \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">Dermatomyofibroma \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">Bundles of cells running parallel to the epidermis. Noninvasive pattern. Increased and fragmented elastic fibers \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">Variable. Usually vimentin<span class="elsevierStyleHsp" style=""></span>+ Stains for smooth muscle actin, desmin, factor <span class="elsevierStyleSmallCaps">xiii</span>a, and CD34 occasionally positive \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">Dermatofibrosarcoma protuberans \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">Storiform pattern, invasion of adnexa and subcutaneous tissue, decreased elastic fibers \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">CD34+ Factor <span class="elsevierStyleSmallCaps">xiii</span>a- \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">Desmoid fibromatosis \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">Infiltrative tumor in the subcutaneous tissue. Dermis spared. \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">Beta-catenin<span class="elsevierStyleHsp" style=""></span>+ Actin<span class="elsevierStyleHsp" style=""></span>+ \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">Fibrous hamartoma of infancy \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">Oval or stellate mesenchymal cells in a myxoid stroma, mature adipocytes \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">Smooth muscle actin<span class="elsevierStyleHsp" style=""></span>+ Calponin<span class="elsevierStyleHsp" style=""></span>+ Some cells: vimentin<span class="elsevierStyleHsp" style=""></span>+ \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">Connective tissue nevus \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">Paucicellular. Predominance of stroma with compact or sclerotic collagen \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">Variable \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">Smooth muscle hamartoma \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">Disordered fascicles of muscle cells \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">Smooth muscle actin<span class="elsevierStyleHsp" style=""></span>+ \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">Myofibromatosis \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">Multinodular configuration, association with hemangiopericytoid vessels \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">Vimentin<span class="elsevierStyleHsp" style=""></span>+ Actin<span class="elsevierStyleHsp" style=""></span>+ \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">Hypopigmented blue nevus \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">Spindle cells orientated parallel to the epidermis \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">S100+ and other melanocytic markers \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">Dermatofibroma \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">Storiform pattern, reduced elastic fibers, presence of histiocytes \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">Factor <span class="elsevierStyleSmallCaps">xiii</span>a+ \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab478848.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Key to the Differential Diagnosis of Mesenchymal Tumors in the Children.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Die plaqueformige dermale fibromatose" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 21 | 6 | 27 |
| 2024 October | 106 | 43 | 149 |
| 2024 September | 112 | 35 | 147 |
| 2024 August | 152 | 71 | 223 |
| 2024 July | 112 | 47 | 159 |
| 2024 June | 133 | 47 | 180 |
| 2024 May | 126 | 43 | 169 |
| 2024 April | 101 | 17 | 118 |
| 2024 March | 102 | 43 | 145 |
| 2024 February | 87 | 48 | 135 |
| 2024 January | 93 | 44 | 137 |
| 2023 December | 86 | 28 | 114 |
| 2023 November | 94 | 62 | 156 |
| 2023 October | 101 | 31 | 132 |
| 2023 September | 102 | 46 | 148 |
| 2023 August | 64 | 36 | 100 |
| 2023 July | 92 | 64 | 156 |
| 2023 June | 73 | 40 | 113 |
| 2023 May | 104 | 50 | 154 |
| 2023 April | 82 | 53 | 135 |
| 2023 March | 88 | 47 | 135 |
| 2023 February | 86 | 42 | 128 |
| 2023 January | 88 | 65 | 153 |
| 2022 December | 72 | 53 | 125 |
| 2022 November | 41 | 34 | 75 |
| 2022 October | 39 | 31 | 70 |
| 2022 September | 43 | 57 | 100 |
| 2022 August | 38 | 51 | 89 |
| 2022 July | 34 | 46 | 80 |
| 2022 June | 34 | 36 | 70 |
| 2022 May | 68 | 61 | 129 |
| 2022 April | 84 | 66 | 150 |
| 2022 March | 106 | 75 | 181 |
| 2022 February | 79 | 85 | 164 |
| 2022 January | 89 | 46 | 135 |
| 2021 December | 62 | 55 | 117 |
| 2021 November | 67 | 54 | 121 |
| 2021 October | 60 | 50 | 110 |
| 2021 September | 60 | 39 | 99 |
| 2021 August | 42 | 39 | 81 |
| 2021 July | 36 | 42 | 78 |
| 2021 June | 49 | 40 | 89 |
| 2021 May | 69 | 38 | 107 |
| 2021 April | 92 | 61 | 153 |
| 2021 March | 83 | 22 | 105 |
| 2021 February | 50 | 30 | 80 |
| 2021 January | 43 | 25 | 68 |
| 2020 December | 37 | 12 | 49 |
| 2020 November | 29 | 20 | 49 |
| 2020 October | 36 | 24 | 60 |
| 2020 September | 39 | 12 | 51 |
| 2020 August | 40 | 21 | 61 |
| 2020 July | 23 | 23 | 46 |
| 2020 June | 33 | 25 | 58 |
| 2020 May | 21 | 20 | 41 |
| 2020 April | 24 | 13 | 37 |
| 2020 March | 22 | 25 | 47 |
| 2020 February | 3 | 8 | 11 |
| 2020 January | 4 | 11 | 15 |
| 2019 December | 8 | 2 | 10 |
| 2019 November | 4 | 1 | 5 |
| 2019 October | 0 | 1 | 1 |
| 2019 September | 8 | 3 | 11 |
| 2019 August | 4 | 6 | 10 |
| 2019 July | 4 | 13 | 17 |
| 2019 June | 4 | 5 | 9 |
| 2019 May | 7 | 11 | 18 |
| 2019 April | 2 | 17 | 19 |
| 2019 March | 0 | 12 | 12 |
| 2019 February | 6 | 7 | 13 |
| 2018 December | 2 | 0 | 2 |
| 2018 November | 3 | 0 | 3 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 4 | 0 | 4 |
| 2018 March | 2 | 0 | 2 |
| 2018 February | 40 | 3 | 43 |
| 2018 January | 56 | 7 | 63 |
| 2017 December | 53 | 6 | 59 |
| 2017 November | 42 | 5 | 47 |
| 2017 October | 44 | 7 | 51 |
| 2017 September | 43 | 9 | 52 |
| 2017 August | 40 | 8 | 48 |
| 2017 July | 31 | 9 | 40 |
| 2017 June | 50 | 10 | 60 |
| 2017 May | 49 | 9 | 58 |
| 2017 April | 49 | 7 | 56 |
| 2017 March | 47 | 2 | 49 |
| 2017 February | 23 | 13 | 36 |
| 2017 January | 38 | 12 | 50 |
| 2016 December | 46 | 9 | 55 |
| 2016 November | 57 | 10 | 67 |
| 2016 October | 66 | 13 | 79 |
| 2016 September | 96 | 15 | 111 |
| 2016 August | 78 | 16 | 94 |
| 2016 July | 57 | 13 | 70 |
| 2016 June | 9 | 12 | 21 |
| 2016 May | 5 | 11 | 16 |
| 2016 April | 11 | 7 | 18 |
| 2016 March | 9 | 3 | 12 |
| 2016 February | 4 | 2 | 6 |
| 2016 January | 7 | 5 | 12 |
| 2015 December | 6 | 3 | 9 |
| 2015 November | 6 | 7 | 13 |
| 2015 October | 4 | 3 | 7 |
| 2015 September | 2 | 3 | 5 |
| 2015 August | 5 | 3 | 8 |
| 2015 July | 44 | 7 | 51 |
| 2015 June | 48 | 9 | 57 |
| 2015 May | 70 | 12 | 82 |
| 2015 April | 48 | 9 | 57 |
| 2015 March | 35 | 13 | 48 |
| 2015 February | 31 | 5 | 36 |
| 2015 January | 47 | 7 | 54 |
| 2014 December | 34 | 5 | 39 |
| 2014 November | 31 | 5 | 36 |
| 2014 October | 32 | 12 | 44 |
| 2014 September | 21 | 8 | 29 |
| 2014 August | 24 | 7 | 31 |
| 2014 July | 22 | 7 | 29 |
| 2014 June | 33 | 10 | 43 |
| 2014 May | 254 | 8 | 262 |
| 2014 April | 79 | 5 | 84 |
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