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
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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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| 2023 Marzo | 75 | 32 | 107 |
| 2023 Febrero | 133 | 34 | 167 |
| 2023 Enero | 173 | 35 | 208 |
| 2022 Diciembre | 118 | 42 | 160 |
| 2022 Noviembre | 77 | 37 | 114 |
| 2022 Octubre | 93 | 26 | 119 |
| 2022 Septiembre | 100 | 41 | 141 |
| 2022 Agosto | 51 | 37 | 88 |
| 2022 Julio | 72 | 47 | 119 |
| 2022 Junio | 31 | 26 | 57 |
| 2022 Mayo | 94 | 51 | 145 |
| 2022 Abril | 95 | 38 | 133 |
| 2022 Marzo | 64 | 59 | 123 |
| 2022 Febrero | 70 | 33 | 103 |
| 2022 Enero | 86 | 38 | 124 |
| 2021 Diciembre | 60 | 41 | 101 |
| 2021 Noviembre | 78 | 54 | 132 |
| 2021 Octubre | 70 | 66 | 136 |
| 2021 Septiembre | 75 | 60 | 135 |
| 2021 Agosto | 114 | 36 | 150 |
| 2021 Julio | 76 | 40 | 116 |
| 2021 Junio | 58 | 41 | 99 |
| 2021 Mayo | 47 | 46 | 93 |
| 2021 Abril | 140 | 33 | 173 |
| 2021 Marzo | 94 | 37 | 131 |
| 2021 Febrero | 44 | 32 | 76 |
| 2021 Enero | 42 | 18 | 60 |
| 2020 Diciembre | 32 | 26 | 58 |
| 2020 Noviembre | 30 | 16 | 46 |
| 2020 Octubre | 23 | 12 | 35 |
| 2020 Septiembre | 26 | 12 | 38 |
| 2020 Agosto | 27 | 17 | 44 |
| 2020 Julio | 20 | 15 | 35 |
| 2020 Junio | 32 | 18 | 50 |
| 2020 Mayo | 22 | 15 | 37 |
| 2020 Abril | 29 | 19 | 48 |
| 2020 Marzo | 34 | 22 | 56 |
| 2020 Febrero | 4 | 9 | 13 |
| 2020 Enero | 8 | 9 | 17 |
| 2019 Diciembre | 8 | 6 | 14 |
| 2019 Noviembre | 4 | 1 | 5 |
| 2019 Octubre | 0 | 2 | 2 |
| 2019 Septiembre | 6 | 12 | 18 |
| 2019 Agosto | 4 | 7 | 11 |
| 2019 Julio | 4 | 25 | 29 |
| 2019 Junio | 4 | 16 | 20 |
| 2019 Mayo | 6 | 5 | 11 |
| 2019 Abril | 2 | 15 | 17 |
| 2019 Marzo | 2 | 11 | 13 |
| 2019 Febrero | 2 | 5 | 7 |
| 2019 Enero | 4 | 6 | 10 |
| 2018 Diciembre | 0 | 9 | 9 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 6 | 0 | 6 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Agosto | 0 | 5 | 5 |
| 2018 Junio | 0 | 1 | 1 |
| 2018 Mayo | 0 | 5 | 5 |
| 2018 Abril | 0 | 4 | 4 |
| 2018 Marzo | 1 | 0 | 1 |
| 2018 Febrero | 61 | 4 | 65 |
| 2018 Enero | 50 | 6 | 56 |
| 2017 Diciembre | 40 | 4 | 44 |
| 2017 Noviembre | 44 | 5 | 49 |
| 2017 Octubre | 44 | 4 | 48 |
| 2017 Septiembre | 53 | 5 | 58 |
| 2017 Agosto | 42 | 9 | 51 |
| 2017 Julio | 32 | 10 | 42 |
| 2017 Junio | 48 | 16 | 64 |
| 2017 Mayo | 43 | 10 | 53 |
| 2017 Abril | 36 | 17 | 53 |
| 2017 Marzo | 24 | 36 | 60 |
| 2017 Febrero | 28 | 10 | 38 |
| 2017 Enero | 53 | 13 | 66 |
| 2016 Diciembre | 77 | 12 | 89 |
| 2016 Noviembre | 130 | 30 | 160 |
| 2016 Octubre | 111 | 9 | 120 |
| 2016 Septiembre | 166 | 18 | 184 |
| 2016 Agosto | 147 | 8 | 155 |
| 2016 Julio | 50 | 9 | 59 |
| 2016 Junio | 6 | 8 | 14 |
| 2016 Mayo | 5 | 10 | 15 |
| 2016 Abril | 5 | 1 | 6 |
| 2016 Marzo | 1 | 10 | 11 |
| 2016 Febrero | 13 | 1 | 14 |
| 2016 Enero | 8 | 2 | 10 |
| 2015 Diciembre | 9 | 1 | 10 |
| 2015 Noviembre | 23 | 3 | 26 |
| 2015 Octubre | 8 | 3 | 11 |
| 2015 Septiembre | 16 | 1 | 17 |
| 2015 Agosto | 22 | 4 | 26 |
| 2015 Julio | 96 | 116 | 212 |
| 2015 Junio | 93 | 10 | 103 |
| 2015 Mayo | 89 | 17 | 106 |
| 2015 Abril | 28 | 1 | 29 |
| 2015 Marzo | 22 | 3 | 25 |
| 2015 Febrero | 30 | 5 | 35 |
| 2015 Enero | 48 | 1 | 49 |
| 2014 Diciembre | 54 | 5 | 59 |
| 2014 Noviembre | 42 | 1 | 43 |
| 2014 Octubre | 78 | 1 | 79 |
| 2014 Septiembre | 63 | 5 | 68 |
| 2014 Agosto | 57 | 1 | 58 |
| 2014 Julio | 59 | 4 | 63 |
| 2014 Junio | 80 | 7 | 87 |
| 2014 Mayo | 67 | 10 | 77 |
| 2014 Abril | 52 | 7 | 59 |
| 2014 Marzo | 54 | 8 | 62 |
| 2014 Febrero | 34 | 9 | 43 |
| 2014 Enero | 44 | 4 | 48 |
| 2013 Diciembre | 43 | 9 | 52 |
| 2013 Noviembre | 27 | 5 | 32 |
| 2013 Octubre | 25 | 8 | 33 |
| 2013 Septiembre | 14 | 10 | 24 |
| 2013 Agosto | 10 | 22 | 32 |
| 2013 Julio | 13 | 14 | 27 |
| 2013 Junio | 0 | 3 | 3 |
| 2013 Mayo | 9 | 13 | 22 |
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