Case and Research Letters
Adult Onset Langerhans Cell Histiocytosis Diagnosed With Xanthoma-like Plaque
Placas similares a xantomas como forma de presentación de una histiocitosis de células de Langerhans en un paciente en edad adulta
a Servicio de Dermatología, Universidad de Eskişehir Osmangazi, Facultad de Medicina, Eskisehir, Turkey
b Servicio de Anatomía Patológica, Universidad de Eskişehir Osmangazi, Facultad de Medicina, Eskisehir, Turkey
c Servicio de Genética Médica, Universidad de Eskişehir Osmangazi, Facultad de Medicina, Eskisehir, Turkey
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Boyuk, I. Bulur, F. Canaz, O. Cilingir" "autores" => array:4 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Boyuk" "email" => array:1 [ 0 => "emineboyuk@gmail.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" => "I." "apellidos" => "Bulur" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:4 [ "nombre" => "F." "apellidos" => "Canaz" "email" => array:1 [ 0 => "fcanaz@ogu.edu.tr" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 3 => array:3 [ "nombre" => "O." "apellidos" => "Cilingir" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Universidad de Eskişehir Osmangazi, Facultad de Medicina, Eskisehir, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Universidad de Eskişehir Osmangazi, Facultad de Medicina, Eskisehir, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Genética Médica, Universidad de Eskişehir Osmangazi, Facultad de Medicina, Eskisehir, Turkey" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding authors." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Placas similares a xantomas como forma de presentación de una histiocitosis de células de Langerhans en un paciente en edad adulta" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 474 "Ancho" => 1255 "Tamanyo" => 118634 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemistry showed CD1a (3a) and CD207 (3b) expression by the cells with eosinophilic cytoplasm and grooved or lobular nucleus.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Langerhans cell histiocytosis (LCH) is a rare, clonal disorder of immature Langerhans cells that can involve various organs and especially the skin, bone, lungs and pituitary gland. The disease is most commonly seen in infants, children and is rare in adulthood.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Skin limited Langerhans cell histiocytosis in adults is even less common.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 73-year-old male patient presented to our clinic complaining of a patch on his back that had appeared about a year ago and gradually enlarged. There was nothing of significance in his medical history. Although he had a 15 pack/year cigarette-smoking history, he had stopped smoking 30 years prior to his diagnosis. The dermatologic examination revealed xanthoma-like plaques on his back, that had composed with the accumulation of yellow-orange papules on an erythematous background, and erythematous papules (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Skin biopsy was taken for differential diagnosis of diffuse plane xanthoma. Histopathological examination revealed dense clusters of Langerhans cells with an eosinophilic cytoplasm, grooved or lobular nucleus; histiocytes with abundant pale cytoplasm, multinucleated giant cells and lymphocytes in the dermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Langerhans cells stained the positive for CD1a, CD207 (langerin) and S100 (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>a-3b). The diagnosis of LCH skin involment was confirmed with histological and immunohistochemical analysis of skin biyopsy. BRAFV600E mutation was been detected in skin tissue sample.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Computed tomography (neck, thorax, abdomen, pelvic), also pituitary magnetic resonance scan failed to demonstrate systemic involvement. The patient was diagnosed with LCH skin involvement. He was referred to pulmonology, medical oncology, hematology and endocrinology departments and there was no extracutaneous involvement.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Treatment was started with topical corticosteroids and PUVA treatment with oral 8- Methoxypsoralen (8-MOP). The patient had photosensitivity reaction to PUVA after 46 sessions and treatment was changed to UVA with topical 0.1% 8-MOP gel. Phototherapy resulted with healing of the erythematous papules, erosions and thinning of the yellow-orange plaques (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The sixth month follow-up thoracic computed tomography image revealed parenchymal involvement consistent with LCH. Bronchoalveolar lavage investigation showed a large number (90%) of histiocytes and a small number of polymorphonuclear leukocytes. The patient was diagnosed with multi-systemic LCH and started methotrexate treatment, in the first week with a 5<span class="elsevierStyleHsp" style=""></span>mg test dose and then as 20<span class="elsevierStyleHsp" style=""></span>mg per weekly. The patient was stable with methotrexate treatment for 6 months.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The diagnosis of LCH is based on clinical and histopathological evidence with microscopic examination and immunohistochemical features of langerhans cells.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a> Detection of LC markers CD1a and CD207 (langerin) is essential to confrim diagnosis and evaluation of Birberck granules on electronic microscopy has been using less frequently.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> İn this case CD1a and CD207 were positive with immunohistochemical investigation of the cells, with eosinophilic cytoplasm and grooved or lobular nucleus.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Skin lesions of LCH can be limited to a single anatomic region or generalized, and consist of diffused papules, nodules or plaques, and can mimic seborrheic dermatitis in addition to prurigo nodularis, eczema, psoriasis, candidiasis or intertrigo.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5</span></a> Since skin involvement can be the initial symptom of systemic disease, these patients should be evaluated in terms of multi-organ involvement.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> Our patient had atypical lesions, xanthoma-like plaques and erythematous papules on his back and waist.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Clinical evidence of LCH vary based on the affected organ or system, from self- healing disease to chronic recurrences and it may resulted in patient being underdiagnosed.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Podjasek et al reported a LCH case, followed-up with a misdiagnosis of inflammatory intestinal disease, was diagnosed with skin lesions and had gastrointestinal, lung and liver involvement. Skin biopsy may be valuable for diagnosis of LCH.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Our case developed lung involvement about 8 months after he was first diagnosed with LCH skin involvement. Additionaly, lung involvement of LCH is more frequently in adults and strongly associated with smoking.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">BRAFV600E mutation has been detected in approximately half of LCH samples. Recently, it is suggested to research BRAFV600E mutation in all samples with difficult cases.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In our case, we detected BRAFV600E mutation in skin tissue sample.</p><p id="par0045" class="elsevierStylePara elsevierViewall">LCH may affect any organs and revised classification contains 4 subtypes of LCH depending on the number of organs or systems involved, lung involvement and involvement of risk organs (liver, spleen and bone marrow).<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Treatment recommendations are determined according severity of disease.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The treatments used include topical and systemic steroid treatment, phototherapy, topical nitrogen mustard, azathioprine and methotrexate.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,8</span></a> In our case erythematous papules, perilesional erythema and eroded areas resolved with PUVA treatment but the xanthoma-like plaques showed thinning.</p><p id="par0050" class="elsevierStylePara elsevierViewall">LCH in adults is difficult to diagnose as it is rare and skin involvement can vary in appearance. Skin biopsy is significant to diagnose skin involvement. It can be the initial sign of multi-systemic LCH although the condition can rarely be limited to the skin. Close follow-up of adult-onset LCH patients with skin involvement is therefore essential in terms of future potential multi-organ involvement.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-02-14" "fechaAceptado" => "2018-06-12" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Boyuk E, et al. Placas similares a xantomas como forma de presentación de una histiocitosis de células de Langerhans en un paciente en edad adulta. Actas Dermosifiliogr. 2020;111:71–73.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 500 "Ancho" => 1255 "Tamanyo" => 103007 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Xanthoma-like plaques on trunk, that had composed with the accumulation of yellow-orange papules on an erythematous background, and erythematous papules. Phototherapy resulted with healing of the erythematous papules, erosions and thinning of the yellow-orange plaques.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 680 "Ancho" => 905 "Tamanyo" => 191568 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Langerhans cells with an eosinophilic cytoplasm, grooved or lobular nucleus, histiocytes with abundant pale cytoplasm and lymphocytes in the dermis.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 474 "Ancho" => 1255 "Tamanyo" => 118634 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemistry showed CD1a (3a) and CD207 (3b) expression by the cells with eosinophilic cytoplasm and grooved or lobular nucleus.</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" => "Management of adult patients with Langerhans cell histiocytosis: recommendations from an expert panel on behalf of Euro-Histio-Net" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Girschikofsky" 1 => "M. Arico" 2 => "D. Castillo" 3 => "A. Chu" 4 => "C. Doberauer" 5 => "J. Fichter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1750-1172-8-72" "Revista" => array:6 [ "tituloSerie" => "Orphanet J Rare Dis" "fecha" => "2013" "volumen" => "8" "paginaInicial" => "72" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23672541" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0890856709635140" "estado" => "S300" "issn" => "08908567" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Langerhans cell histiocytosis first presenting in the skin in adults: frequent association with a second haematological malignancy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.R. Edelbroek" 1 => "M.H. Vermeer" 2 => "P.M. Jansen" 3 => "T.J. Stoof" 4 => "M.M. van der Linden" 5 => "B. Horváth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2012.11169.x" "Revista" => array:5 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2012" "volumen" => "167" "paginaInicial" => "1287" "paginaFinal" => "1294" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Langerhans cell histiocytosis in the elderly: a report of three cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.M. Stefanato" 1 => "W.K. Andersen" 2 => "E. Calonje" 3 => "F.A. Swain" 4 => "S. Borghi" 5 => "L. Massone" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1998" "volumen" => "39 2 Pt 2" "paginaInicial" => "375" "paginaFinal" => "378" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Histiocyte Society. Revised classification of histiocytoses and neoplasms of the macrophage-dendritic cell lineages" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.F. Emile" 1 => "O. Abla" 2 => "S. Fraitag" 3 => "A. Horne" 4 => "J. Haroche" 5 => "J. Donadieu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/blood-2016-01-690636" "Revista" => array:6 [ "tituloSerie" => "Blood" "fecha" => "2016" "volumen" => "127" "paginaInicial" => "2672" "paginaFinal" => "2681" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26966089" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extensive cutaneous Langerhans cell histiocytosis in an elderly woman" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Wang" 1 => "X. Wang" 2 => "J. Hong" 3 => "Z. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1346-8138.2010.01098.x" "Revista" => array:6 [ "tituloSerie" => "J Dermatol" "fecha" => "2011" "volumen" => "38" "paginaInicial" => "794" "paginaFinal" => "797" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21806673" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Langerhans cell histiocytosis in an adult patient presenting with eruptions on the scalp and trunk accompanied by lytic lesions on the skull" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Ishibashi" 1 => "E. Izumi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ijd.13225" "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2016" "volumen" => "55" "paginaInicial" => "e408" "paginaFinal" => "e410" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26873568" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adult-onset systemic Langerhans cell histiocytosis mimicking inflammatory bowel disease: the value of skin biopsy and review of cases of Langerhans cell histiocytosis with cutaneous involvement seen at the Mayo Clinic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.O. Podjasek" 1 => "C.G. Loftus" 2 => "T.C. Smyrk" 3 => "C.N. Wieland" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-4632.2012.05716.x" "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2014" "volumen" => "53" "paginaInicial" => "305" "paginaFinal" => "311" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23621577" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adult-onset Langerhans cell histiocytosis confined to the skin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K. Aydogan" 1 => "S. Tunali" 2 => "S. Koran Karadogan" 3 => "S. Balaban Adim" 4 => "H. Turan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-3083.2006.01566" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2006" "volumen" => "20" "paginaInicial" => "890" "paginaFinal" => "892" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16898928" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011100000001/v2_202004200619/S1578219019303440/v2_202004200619/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011100000001/v2_202004200619/S1578219019303440/v2_202004200619/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019303440?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 10 | 24 |
| 2024 October | 88 | 45 | 133 |
| 2024 September | 109 | 35 | 144 |
| 2024 August | 109 | 63 | 172 |
| 2024 July | 95 | 43 | 138 |
| 2024 June | 126 | 46 | 172 |
| 2024 May | 99 | 50 | 149 |
| 2024 April | 84 | 42 | 126 |
| 2024 March | 95 | 48 | 143 |
| 2024 February | 69 | 43 | 112 |
| 2024 January | 84 | 41 | 125 |
| 2023 December | 65 | 19 | 84 |
| 2023 November | 112 | 27 | 139 |
| 2023 October | 81 | 25 | 106 |
| 2023 September | 76 | 31 | 107 |
| 2023 August | 61 | 21 | 82 |
| 2023 July | 62 | 39 | 101 |
| 2023 June | 54 | 32 | 86 |
| 2023 May | 69 | 27 | 96 |
| 2023 April | 47 | 30 | 77 |
| 2023 March | 75 | 34 | 109 |
| 2023 February | 53 | 19 | 72 |
| 2023 January | 47 | 33 | 80 |
| 2022 December | 75 | 31 | 106 |
| 2022 November | 62 | 31 | 93 |
| 2022 October | 42 | 27 | 69 |
| 2022 September | 40 | 29 | 69 |
| 2022 August | 49 | 34 | 83 |
| 2022 July | 39 | 34 | 73 |
| 2022 June | 32 | 29 | 61 |
| 2022 May | 94 | 49 | 143 |
| 2022 April | 85 | 44 | 129 |
| 2022 March | 82 | 53 | 135 |
| 2022 February | 78 | 35 | 113 |
| 2022 January | 86 | 63 | 149 |
| 2021 December | 81 | 43 | 124 |
| 2021 November | 70 | 42 | 112 |
| 2021 October | 113 | 47 | 160 |
| 2021 September | 55 | 43 | 98 |
| 2021 August | 54 | 48 | 102 |
| 2021 July | 64 | 28 | 92 |
| 2021 June | 64 | 17 | 81 |
| 2021 May | 54 | 43 | 97 |
| 2021 April | 100 | 49 | 149 |
| 2021 March | 45 | 40 | 85 |
| 2021 February | 41 | 26 | 67 |
| 2021 January | 32 | 21 | 53 |
| 2020 December | 36 | 13 | 49 |
| 2020 November | 28 | 20 | 48 |
| 2020 October | 37 | 18 | 55 |
| 2020 September | 26 | 17 | 43 |
| 2020 August | 34 | 12 | 46 |
| 2020 July | 24 | 11 | 35 |
| 2020 June | 17 | 16 | 33 |
| 2020 May | 32 | 14 | 46 |
| 2020 April | 54 | 27 | 81 |
| 2020 March | 28 | 12 | 40 |
| 2020 February | 4 | 2 | 6 |
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