Case Report
Recurrent Pyogenic Granuloma
Granuloma piogénico recidivante
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"apellidos" => "Millán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Dermatología, Hospital General de Castelló, Castellón, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Dermatología, Consorci Hospital General Universitari de València, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Dermatología, Hospital Arnau de Vilanova, Valencia, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Granuloma piogénico recidivante" ] ] "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" => 850 "Ancho" => 1301 "Tamanyo" => 430314 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Lobular proliferation of capillaries with epidermal collarette at the periphery (hematoxylin-eosin, ×40).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Pyogenic granuloma is a very common vascular proliferation that usually presents as a solitary, sessile, or pedunculated lesion with a fragile surface prone to bleeding, ulceration, and crusting. Local recurrence after treatment is very common. However, the appearance of multiple satellite lesions after excision of the initial lesion is a rare complication of pyogenic granuloma and can present problems of diagnosis and management. Such lesions, known as recurrent pyogenic granuloma (RPG), were described by Warner and Wilson Jones in 1968.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> We present 5 cases of RPG, most of which are in pediatric patients.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case Description</span><p id="par0010" class="elsevierStylePara elsevierViewall">We performed a retrospective study that identified 5 patients who had been diagnosed with pyogenic granuloma in the Dermatology Department of Hospital General de Valencia, Spain, and had subsequently developed satellite angiomatous lesions. Photographs of the recurrent lesions, histopathology, and a detailed history of the development of the lesions were assessed. The patients were 3 females and 2 males (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) aged 4 to 31 years (mean, 13 y). The lesions were located on the trunk or thighs and appeared after the initial treatment for pyogenic granuloma by surgical excision or electrodessication (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). The time from initial treatment to the appearance of RPG ranged from 1 to 9 months (mean, 3 mo). In all cases the RPG lesions disappeared spontaneously, beginning to regress after 45 to 120 days (mean, 81 d).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Biopsies of the recurrent lesions revealed typical findings of pyogenic granuloma. The dermis was occupied by lobes of prominent endothelial cells with formation of small vascular spaces. The endothelial cells showed no atypia and no inflammation. The lesion was surrounded by an epidermal collarette (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">RPG is a rare and therefore little-known disease. It is mainly found in males under the age of 25 years. Interestingly, RPG lesions do not appear in the places where pyogenic granuloma lesions often appear, such as the hands, face, nasal mucosa, gums, and lips.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The main site of multiple recurrent lesions is the trunk, particularly the interscapular region.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,4</span></a> Most satellite lesions appear between 1 week and 4 months after treatment of the primary tumor but they can occur up to 2 years after treatment.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> In rare cases there can be a second recurrence after treatment of the RPG lesions.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The satellite lesions tend to be asymptomatic, bright red, sessile papules of 1 to 10<span class="elsevierStyleHsp" style=""></span>mm diameter with the surface intact.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Possible predisposing factors for the appearance of pyogenic granulomas are trauma, chronic irritation, infections, viral oncogenes, and microscopic arteriovenous anastomosis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The pathogenesis of satellite metastasis is not well known. It has been suggested that after treatment of the primary lesion angiogenic factors may promote the appearance of new lesions. However, the risk of recurrent lesions does not appear to be related to the treatment method used for the initial tumor because this condition has been described after surgical excision, cautery, carbon dioxide laser excision, ligation, and curettage.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> It has also been observed following irritation of the primary lesion.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,9</span></a> In 1 case <span class="elsevierStyleItalic">Bartonella henselae</span> was identified in lesions of an immunocompetent man, leading the authors of that case report to suggest that RPG might be a localized variant of bacillary angiomatosis,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> although this hypothesis has not been confirmed in subsequent case reports.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Histological findings in RPG are identical to those of any other variant of pyogenic granuloma, with the exception that smaller recurrent lesions are very similar to capillary hemangiomas.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Initially they are identical to granulation tissue, with numerous capillaries and venules distributed radially to the skin surface in edematous stroma with mixed inflammatory infiltrate. In more advanced stages, fibrous septa partition the lesion into lobules composed of aggregates of capillaries and venules with prominent endothelial cells but no stromal edema and little inflammatory infiltration. Finally, fibroplasia replaces the lobules of capillaries until the lesion transforms into a fibroma.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In a few cases of recurrent lesions, anastomosing vascular channels dissect collagen bundles, especially in the deep areas, with an appearance similar to angiosarcoma.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,12</span></a> The ultrastructural study also fails to distinguish the endothelial cells of the recurrent lesions from simple pyogenic granuloma.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">A conservative approach is an appropriate option, because most untreated recurrent lesions disappear spontaneously in 6 to 12 months.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> When treatment is prescribed, the same methods as those of simple pyogenic granuloma are used. The treatments include Nd:YAG laser,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> topical imiquimod,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and intralesional bleomycin,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> in addition to systemic corticosteroids for giant lesions in the proliferative phase.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">We have reported 5 cases of RPG, the largest series after the initial description by Warner and Jones.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Our observations are in agreement with the finding that the lesions appear in young people, even in children, and are mainly located on the trunk and limbs around the scar from treatment of the primary lesion. Histopathology is necessary to confirm the diagnosis. In all cases the lesions disappeared completely without treatment, so we recommend a conservative approach. It is important to identify RPG because the appearance of satellite lesions after treatment of a tumor disease can be a concern for physicians who are not familiar with this condition.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres96037" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec83196" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres96036" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec83195" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case Description" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of Interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec83196" "palabras" => array:3 [ 0 => "Pyogenic granuloma" 1 => "Recurrence" 2 => "Satellitosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec83195" "palabras" => array:3 [ 0 => "Granuloma piogénico" 1 => "Recidivante" 2 => "Satelitosis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The appearance of multiple satellite lesions is a rare complication of the treatment of a primary pyogenic granuloma lesion. We report 5 cases of recurrent pyogenic granuloma in patients aged between 4 and 31 years. The lesions resolved spontaneously after 1 to 9 months. Although the diagnosis and treatment of recurrent pyogenic granuloma can be problematic, this condition is benign and frequently self-limiting.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El desarrollo de múltiples lesiones satélite de granuloma piogénico tras el tratamiento de la lesión primaria es un trastorno poco frecuente. Comunicamos 5 casos de granuloma piogénico recidivante en pacientes con edades comprendidas entre los 4 y los 31 años, con lesiones que se resolvieron espontáneamente al cabo de 1-9 meses. Aunque puede plantear problemas diagnósticos y terapéuticos, es una entidad benigna y con frecuencia autolimitada.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Pitarch G, Pérez-Ferriols A, Millán F. Granuloma piogénico recidivante. Actas Dermosifiliogr.2012;103: 536-539.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 564 "Ancho" => 751 "Tamanyo" => 105087 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Pyogenic granulomas of different sizes, 1 biopsied, around the scar from the primary lesion on the thigh.</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" => 666 "Ancho" => 851 "Tamanyo" => 102582 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Vascular-appearing papules on the periphery of the scar from shave excision of the primary pyogenic granuloma.</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" => 850 "Ancho" => 1301 "Tamanyo" => 430314 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Lobular proliferation of capillaries with epidermal collarette at the periphery (hematoxylin-eosin, ×40).</p>" ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">PG, pyogenic granuloma.</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="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">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">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 of Primary PG \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">Latency Period, mo \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 Course \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">9 \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">Male \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">Scapula \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">Surgical excision \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="char" 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">Regression at 45 d \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">15 \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">Female \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">Thigh \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">Electrodessication \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \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">Regression at 2 mo \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">Female \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">Abdomen \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">Surgical excision \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="char" 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">Regression at 2 mo \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">31 \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">Male \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">Thigh \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">Surgical excision \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="char" 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">Regression at 4 mo \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">Female \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">Clavicle \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">Surgical excision \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="char" 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">Regression at 4 mo \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab182218.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Demographic Characteristics of Patients With the Site and Clinical Course of Recurrent 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 38 | 7 | 45 |
| 2024 Octubre | 346 | 67 | 413 |
| 2024 Septiembre | 397 | 45 | 442 |
| 2024 Agosto | 377 | 86 | 463 |
| 2024 Julio | 378 | 56 | 434 |
| 2024 Junio | 257 | 80 | 337 |
| 2024 Mayo | 241 | 47 | 288 |
| 2024 Abril | 205 | 44 | 249 |
| 2024 Marzo | 232 | 47 | 279 |
| 2024 Febrero | 219 | 34 | 253 |
| 2024 Enero | 285 | 41 | 326 |
| 2023 Diciembre | 285 | 33 | 318 |
| 2023 Noviembre | 300 | 29 | 329 |
| 2023 Octubre | 235 | 39 | 274 |
| 2023 Septiembre | 235 | 47 | 282 |
| 2023 Agosto | 177 | 23 | 200 |
| 2023 Julio | 224 | 47 | 271 |
| 2023 Junio | 218 | 25 | 243 |
| 2023 Mayo | 234 | 33 | 267 |
| 2023 Abril | 187 | 30 | 217 |
| 2023 Marzo | 92 | 31 | 123 |
| 2023 Febrero | 108 | 41 | 149 |
| 2023 Enero | 153 | 34 | 187 |
| 2022 Diciembre | 124 | 46 | 170 |
| 2022 Noviembre | 82 | 33 | 115 |
| 2022 Octubre | 82 | 33 | 115 |
| 2022 Septiembre | 96 | 47 | 143 |
| 2022 Agosto | 79 | 43 | 122 |
| 2022 Julio | 61 | 43 | 104 |
| 2022 Junio | 72 | 30 | 102 |
| 2022 Mayo | 161 | 53 | 214 |
| 2022 Abril | 231 | 49 | 280 |
| 2022 Marzo | 279 | 67 | 346 |
| 2022 Febrero | 259 | 48 | 307 |
| 2022 Enero | 251 | 60 | 311 |
| 2021 Diciembre | 208 | 55 | 263 |
| 2021 Noviembre | 235 | 68 | 303 |
| 2021 Octubre | 426 | 67 | 493 |
| 2021 Septiembre | 165 | 32 | 197 |
| 2021 Agosto | 202 | 51 | 253 |
| 2021 Julio | 169 | 56 | 225 |
| 2021 Junio | 184 | 48 | 232 |
| 2021 Mayo | 161 | 45 | 206 |
| 2021 Abril | 474 | 71 | 545 |
| 2021 Marzo | 286 | 42 | 328 |
| 2021 Febrero | 177 | 38 | 215 |
| 2021 Enero | 136 | 33 | 169 |
| 2020 Diciembre | 152 | 21 | 173 |
| 2020 Noviembre | 113 | 27 | 140 |
| 2020 Octubre | 107 | 45 | 152 |
| 2020 Septiembre | 94 | 17 | 111 |
| 2020 Agosto | 108 | 27 | 135 |
| 2020 Julio | 88 | 26 | 114 |
| 2020 Junio | 80 | 30 | 110 |
| 2020 Mayo | 67 | 38 | 105 |
| 2020 Abril | 43 | 31 | 74 |
| 2020 Marzo | 55 | 38 | 93 |
| 2020 Febrero | 9 | 18 | 27 |
| 2020 Enero | 0 | 26 | 26 |
| 2019 Diciembre | 2 | 14 | 16 |
| 2019 Noviembre | 0 | 3 | 3 |
| 2019 Octubre | 0 | 5 | 5 |
| 2019 Septiembre | 4 | 9 | 13 |
| 2019 Agosto | 0 | 10 | 10 |
| 2019 Julio | 0 | 16 | 16 |
| 2019 Junio | 2 | 21 | 23 |
| 2019 Mayo | 1 | 22 | 23 |
| 2019 Abril | 0 | 21 | 21 |
| 2019 Marzo | 2 | 15 | 17 |
| 2019 Febrero | 0 | 4 | 4 |
| 2019 Enero | 1 | 2 | 3 |
| 2018 Diciembre | 0 | 8 | 8 |
| 2018 Noviembre | 1 | 2 | 3 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 4 | 2 | 6 |
| 2018 Agosto | 0 | 18 | 18 |
| 2018 Julio | 0 | 8 | 8 |
| 2018 Junio | 0 | 16 | 16 |
| 2018 Mayo | 0 | 12 | 12 |
| 2018 Abril | 0 | 14 | 14 |
| 2018 Marzo | 2 | 13 | 15 |
| 2018 Febrero | 236 | 15 | 251 |
| 2018 Enero | 166 | 25 | 191 |
| 2017 Diciembre | 166 | 8 | 174 |
| 2017 Noviembre | 153 | 23 | 176 |
| 2017 Octubre | 151 | 15 | 166 |
| 2017 Septiembre | 101 | 13 | 114 |
| 2017 Agosto | 119 | 20 | 139 |
| 2017 Julio | 111 | 26 | 137 |
| 2017 Junio | 121 | 39 | 160 |
| 2017 Mayo | 120 | 17 | 137 |
| 2017 Abril | 109 | 21 | 130 |
| 2017 Marzo | 128 | 29 | 157 |
| 2017 Febrero | 114 | 18 | 132 |
| 2017 Enero | 91 | 13 | 104 |
| 2016 Diciembre | 176 | 28 | 204 |
| 2016 Noviembre | 237 | 27 | 264 |
| 2016 Octubre | 213 | 31 | 244 |
| 2016 Septiembre | 249 | 20 | 269 |
| 2016 Agosto | 241 | 15 | 256 |
| 2016 Julio | 103 | 22 | 125 |
| 2016 Junio | 13 | 23 | 36 |
| 2016 Mayo | 4 | 15 | 19 |
| 2016 Abril | 10 | 1 | 11 |
| 2016 Marzo | 10 | 1 | 11 |
| 2016 Febrero | 13 | 3 | 16 |
| 2016 Enero | 14 | 1 | 15 |
| 2015 Diciembre | 11 | 3 | 14 |
| 2015 Noviembre | 44 | 6 | 50 |
| 2015 Octubre | 64 | 4 | 68 |
| 2015 Septiembre | 32 | 1 | 33 |
| 2015 Agosto | 23 | 4 | 27 |
| 2015 Julio | 226 | 14 | 240 |
| 2015 Junio | 156 | 20 | 176 |
| 2015 Mayo | 171 | 17 | 188 |
| 2015 Abril | 188 | 10 | 198 |
| 2015 Marzo | 186 | 11 | 197 |
| 2015 Febrero | 155 | 8 | 163 |
| 2015 Enero | 105 | 13 | 118 |
| 2014 Diciembre | 116 | 8 | 124 |
| 2014 Noviembre | 100 | 11 | 111 |
| 2014 Octubre | 115 | 16 | 131 |
| 2014 Septiembre | 88 | 9 | 97 |
| 2014 Agosto | 92 | 15 | 107 |
| 2014 Julio | 107 | 27 | 134 |
| 2014 Junio | 72 | 5 | 77 |
| 2014 Mayo | 64 | 7 | 71 |
| 2014 Abril | 49 | 4 | 53 |
| 2014 Marzo | 64 | 23 | 87 |
| 2014 Febrero | 57 | 22 | 79 |
| 2014 Enero | 54 | 17 | 71 |
| 2013 Diciembre | 46 | 19 | 65 |
| 2013 Noviembre | 57 | 13 | 70 |
| 2013 Octubre | 31 | 19 | 50 |
| 2013 Septiembre | 33 | 28 | 61 |
| 2013 Agosto | 24 | 70 | 94 |
| 2013 Julio | 16 | 73 | 89 |
| 2013 Junio | 14 | 97 | 111 |
| 2013 Mayo | 14 | 54 | 68 |
| 2013 Abril | 11 | 42 | 53 |
| 2013 Marzo | 18 | 14 | 32 |
| 2013 Febrero | 35 | 3 | 38 |
| 2013 Enero | 79 | 7 | 86 |
| 2012 Diciembre | 36 | 4 | 40 |
| 2012 Noviembre | 2 | 0 | 2 |
| 2012 Octubre | 1 | 0 | 1 |
| 2012 Septiembre | 0 | 5 | 5 |
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