Case and Research Letter
Small-Cell Neuroendocrine Carcinoma, Not Merkel Cell Carcinoma, in the Sinonasal Region: A Case Report
Carcinoma neuroendocrino de células pequeñas de la región nasosinusal no carcinoma de células de Merkel: presentación de un caso
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Biopsia de 5<span class="elsevierStyleHsp" style=""></span>mm del nódulo nasal. Se observa una proliferación neoplásica difusa en dermis profunda, hipodermis y capa muscular (H-E×10). B. Las células neoplásicas son pequeñas, monomorfas, redondas, con escaso citoplasma y núcleos basófilos (H-E<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>400).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "N. Rivas-Tolosa, B. Llombart, V. Traves, C. Guillén" "autores" => array:4 [ 0 => array:2 [ "nombre" => "N." "apellidos" => "Rivas-Tolosa" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Llombart" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Traves" ] 3 => array:2 [ "nombre" => "C." 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Rivas-Tolosa, B. Llombart, V. Traves, C. Guillén" "autores" => array:4 [ 0 => array:4 [ "nombre" => "N." "apellidos" => "Rivas-Tolosa" "email" => array:1 [ 0 => "nancyrivastolosa@yahoo.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" => "B." "apellidos" => "Llombart" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "V." "apellidos" => "Traves" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "C." "apellidos" => "Guillén" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Fundación Instituto Valenciano de Oncología, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Carcinoma neuroendocrino de células pequeñas de la región nasosinusal no carcinoma de células de Merkel: presentación de un caso" ] ] "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" => 879 "Ancho" => 2335 "Tamanyo" => 703912 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, A 5-mm biopsy of the nasal nodule. A diffuse proliferation of neoplastic cells is visible in the deep dermis, hypodermis, and muscle layer. Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10. B, The neoplastic cells are small, round, and monomorphic, with scant cytoplasm and basophilic nuclei. Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>400.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Small-cell neuroendocrine carcinoma (SCNC) in the sinonasal region is a relatively rare, aggressive tumor with a high rate of recurrence and metastasis. It was first described in 1965 by Raychowdhuri<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> and approximately 50 cases have been published since that time. The majority of SCNCs affect the lungs and only around 4% are located at other sites.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 32-year-old woman with no past history of interest. She consulted for progressively increasing pain and inflammation on the dorsum of the nose that had started 2 months earlier. Physical examination revealed a solid, fixed nodule with a smooth surface on the right lateral surface of the dorsum of the nose. The nodule measured approximately 3<span class="elsevierStyleHsp" style=""></span>cm in its longest diameter (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>); in addition, there was a palpable right jugulodigastric lymph node. Magnetic resonance imaging of the paranasal sinuses revealed a nodular lesion of the external nose that eroded the right nasal bones. On skin biopsy, a diffuse infiltration of neoplastic cells was observed in the deep dermis, hypodermis, and muscle layer. The cells were small and round, with scant cytoplasm and basophilic nuclei (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A and<span class="elsevierStyleHsp" style=""></span>B). Immunohistochemistry (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>) showed a phenotypic profile positive for neuroendocrine (chromogranin A and CD56) and epithelial (cytokeratin AE1/AE3) markers and for thyroid transcription factor<span class="elsevierStyleHsp" style=""></span>1 (TTF-1) and negative for cytokeratin<span class="elsevierStyleHsp" style=""></span>20 (CK20), cytokeratin<span class="elsevierStyleHsp" style=""></span>7 (CK7), protein S-100, glial fibrillary acidic protein (GFAP), neurofilaments, and Epstein Barr virus (EBV) antigen. The cervical lymph node was biopsied and the histologic and immunohistochemical findings were consistent with SCNC arising from the seromucous glands of the sinonasal region. Study of tumor spread by cervical-thoracic-abdominopelvic computed tomography (CT) revealed multiple proliferative malignant implants in the liver. The case was discussed in the tumor committee and, in view of the presence of disseminated disease, salvage surgical treatment of the primary tumor was excluded and it was decided to start chemotherapy with cisplatin and etoposide, combined with radiation therapy. Six months after the diagnosis of the carcinoma, after 8 cycles of chemotherapy, the patient died of liver failure secondary to metastatic infiltration by the tumor.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">SCNC of the sinonasal region arises from the APUD cells of the neuroendocrine system that are occasionally present in the seromucous glands of the nasal cavity and in the accessory salivary glands.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> These tumors affect men and women equally, and the mean age at onset is 50 years. No risk factors have been identified, nor is there evidence to suggest that the presence of EBV is related to the pathogenesis of this tumor; infection by this virus has been well documented in other types of sinonasal carcinoma.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Histopathology study using hematoxylin and eosin (H&E) stain reveals a diffuse infiltration of neoplastic cells that mainly affects the dermis and that is formed of small cells with scant cytoplasm and large, densely hyperchromatic nuclei; mitotic figures and areas of necrosis can be seen.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Immunohistochemistry, though nonspecific, is the most useful diagnostic tool and is based on positivity for markers of epithelial differentiation (CK, AE1/AE3, and CAM 5.2) and neuroendocrine differentiation (chromogranin A, synaptophysin, and/or neuron-specific enolase [NSE]. Immunohistochemistry is negative for protein S-100 and neurofilaments, which helps to exclude other diseases that can have a similar appearance with H&E stain, such as small cell melanoma and stesioneuroblastoma.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The diagnostic challenge, because of the similar clinical and histological characteristics, arises with 2 diseases: Merkel cell carcinoma, which is usually CK20-positive<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> and TTF-1–negative<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>; and skin metastases of small-cell lung cancer,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> whose cells stain positive for CK7 and TTF-1. In the case of SCNC of the sinonasal region, CK7 and CK20 are negative and, if the cells are positive for TTF-1, imaging studies must be performed to confirm the absence of lung disease. In our patient, we confirmed the absence of a lung tumor by CT, which was performed as part of the workup for tumor spread.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Although there is little experience in the management of this type of tumor, neoadjuvant cytoreductive chemotherapy with cisplatin and etoposide is considered to be the treatment of choice.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Other authors recommend wide excision of the lesion as the initial treatment, associated with radiation therapy and chemotherapy,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> as long as metastatic disease has been excluded at the time of diagnosis.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Metastases usually affect the brain, lung, and skeleton. Mean survival after diagnosis is between 2 and 3 years, and the most unfavorable prognostic factors are locoregional invasion and associated paraneoplastic endocrine syndromes.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">It is important for dermatologists to be aware of the existence, characteristics, and clinical course of SCNC of the sinonasal region in order to differentiate it from other neuroendocrine tumors that can be clinically and histologically indistinguishable, such as Merkel cell tumor.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rivas-Tolosa N, Llombart B, Traves V, Guillén C. Carcinoma neuroendocrino de células pequeñas de la región nasosinusal no carcinoma de células de Merkel: presentación de un caso. Actas Dermosifiliogr. 2015;106:143–145.</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" => 1166 "Ancho" => 2085 "Tamanyo" => 199011 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A solid nodule with a smooth surface and irregular outline on the right lateral surface of the dorsum of the nose.</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" => 879 "Ancho" => 2335 "Tamanyo" => 703912 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, A 5-mm biopsy of the nasal nodule. A diffuse proliferation of neoplastic cells is visible in the deep dermis, hypodermis, and muscle layer. Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10. B, The neoplastic cells are small, round, and monomorphic, with scant cytoplasm and basophilic nuclei. Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>400.</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" => 2334 "Ancho" => 2088 "Tamanyo" => 1516063 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemistry shows that the cells are positive for epithelial and neuroendocrine markers; negativity for cytokeratin (CK) and CK7 associated with positivity for thyroid transcription factor (TTF) 1 helps to exclude other diagnoses such as Merkel cell tumor.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Oat cell carcinoma and paranasal sinuses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Raychowdhuri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Laryngol Otol" "fecha" => "1965" "volumen" => "79" "paginaInicial" => "253" "paginaFinal" => "255" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14270662" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extrapulmonary oat cell carcinoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N.B. Ibrahim" 1 => "J.C. Briggs" 2 => "C.M. Corbishley" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cancer" "fecha" => "1984" "volumen" => "15" "paginaInicial" => "1645" "paginaFinal" => "1661" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Small cell (oat cell) carcinoma of minor salivary gland origin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.G. Koss" 1 => "R.H. Spiro" 2 => "S. Hajdu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "1972" "volumen" => "30" "paginaInicial" => "737" "paginaFinal" => "741" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4342409" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Small cell neuroendocrine carcinoma of the nasal cavity and paranasal sinuses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B. Perez-Ordonez" 1 => "S.M. Caruana" 2 => "A.G. Huvos" 3 => "J.P. Shah" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Hum Pathol" "fecha" => "1998" "volumen" => "29" "paginaInicial" => "826" "paginaFinal" => "832" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9712424" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carcinoma de células de Merkel: estudio histopatológico, inmunohistoquímico, ultraestructural y molecular" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Aneiros-Fernández" 1 => "A. Almodóvar-Real" 2 => "M. Caba-Molina" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Monogr Dermatol" "fecha" => "2013" "volumen" => "26" "paginaInicial" => "57" "paginaFinal" => "63" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Value of thyroid transcription factor-1 immunostaining in distinguishing small cell lung carcinomas from other small cell carcinomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "N.G. Ordóñez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Surg Pathol" "fecha" => "2000" "volumen" => "24" "paginaInicial" => "1217" "paginaFinal" => "1223" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10976695" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuroendocrine tumor with an atypical clinical course: A description of 2 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I. Arrue" 1 => "M.A. Arregui" 2 => "B. Catón" 3 => "R. Soloeta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2012.10.014" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2014" "volumen" => "105" "paginaInicial" => "94" "paginaFinal" => "96" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23260877" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuro-endocrine tumours of the head and neck" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.C. Soussi" 1 => "A. Benghiat" 2 => "C.S. Holgate" 3 => "B. Majumdar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Laryngol Otol" "fecha" => "1990" "volumen" => "104" "paginaInicial" => "504" "paginaFinal" => "507" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2165513" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Small cell carcinoma of the nose and paranasal sinuses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.E. Rejowski" 1 => "R.S. Campanella" 2 => "L.J. Block" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Otolaryngol Head Neck Surg" "fecha" => "1982" "volumen" => "90" "paginaInicial" => "516" "paginaFinal" => "517" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6294577" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Small cell neuroendocrine carcinoma of the nasal cavity and paranasal sinuses" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Babin" 1 => "V. Rouleau" 2 => "P.O. Vedrine" 3 => "B. Toussaint" 4 => "D. de Raucourt" 5 => "O. Malard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1017/S0022215106000594" "Revista" => array:6 [ "tituloSerie" => "J Laryngol Otol" "fecha" => "2006" "volumen" => "120" "paginaInicial" => "289" "paginaFinal" => "297" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16526967" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010600000002/v2_201502240233/S1578219014003291/v2_201502240233/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/15782190/0000010600000002/v2_201502240233/S1578219014003291/v2_201502240233/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014003291?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 10 | 12 | 22 |
| 2024 Octubre | 74 | 38 | 112 |
| 2024 Septiembre | 68 | 22 | 90 |
| 2024 Agosto | 110 | 45 | 155 |
| 2024 Julio | 79 | 27 | 106 |
| 2024 Junio | 76 | 53 | 129 |
| 2024 Mayo | 59 | 29 | 88 |
| 2024 Abril | 76 | 26 | 102 |
| 2024 Marzo | 71 | 41 | 112 |
| 2024 Febrero | 72 | 45 | 117 |
| 2024 Enero | 70 | 36 | 106 |
| 2023 Diciembre | 53 | 23 | 76 |
| 2023 Noviembre | 64 | 32 | 96 |
| 2023 Octubre | 63 | 15 | 78 |
| 2023 Septiembre | 71 | 32 | 103 |
| 2023 Agosto | 31 | 25 | 56 |
| 2023 Julio | 69 | 45 | 114 |
| 2023 Junio | 53 | 38 | 91 |
| 2023 Mayo | 61 | 21 | 82 |
| 2023 Abril | 50 | 17 | 67 |
| 2023 Marzo | 47 | 20 | 67 |
| 2023 Febrero | 29 | 25 | 54 |
| 2023 Enero | 42 | 18 | 60 |
| 2022 Diciembre | 50 | 36 | 86 |
| 2022 Noviembre | 27 | 23 | 50 |
| 2022 Octubre | 29 | 20 | 49 |
| 2022 Septiembre | 33 | 38 | 71 |
| 2022 Agosto | 32 | 40 | 72 |
| 2022 Julio | 34 | 50 | 84 |
| 2022 Junio | 19 | 28 | 47 |
| 2022 Mayo | 41 | 34 | 75 |
| 2022 Abril | 35 | 36 | 71 |
| 2022 Marzo | 72 | 49 | 121 |
| 2022 Febrero | 55 | 26 | 81 |
| 2022 Enero | 44 | 24 | 68 |
| 2021 Diciembre | 37 | 39 | 76 |
| 2021 Noviembre | 46 | 47 | 93 |
| 2021 Octubre | 61 | 34 | 95 |
| 2021 Septiembre | 41 | 36 | 77 |
| 2021 Agosto | 40 | 20 | 60 |
| 2021 Julio | 30 | 20 | 50 |
| 2021 Junio | 24 | 28 | 52 |
| 2021 Mayo | 27 | 35 | 62 |
| 2021 Abril | 53 | 100 | 153 |
| 2021 Marzo | 49 | 24 | 73 |
| 2021 Febrero | 28 | 23 | 51 |
| 2021 Enero | 21 | 21 | 42 |
| 2020 Diciembre | 29 | 12 | 41 |
| 2020 Noviembre | 20 | 14 | 34 |
| 2020 Octubre | 10 | 8 | 18 |
| 2020 Septiembre | 33 | 16 | 49 |
| 2020 Agosto | 16 | 24 | 40 |
| 2020 Julio | 14 | 10 | 24 |
| 2020 Junio | 29 | 13 | 42 |
| 2020 Mayo | 27 | 17 | 44 |
| 2020 Abril | 28 | 18 | 46 |
| 2020 Marzo | 31 | 17 | 48 |
| 2020 Febrero | 1 | 8 | 9 |
| 2020 Enero | 0 | 9 | 9 |
| 2019 Diciembre | 0 | 4 | 4 |
| 2019 Noviembre | 0 | 1 | 1 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 2 | 1 | 3 |
| 2019 Agosto | 0 | 1 | 1 |
| 2019 Julio | 0 | 7 | 7 |
| 2019 Junio | 0 | 9 | 9 |
| 2019 Mayo | 0 | 9 | 9 |
| 2019 Abril | 0 | 14 | 14 |
| 2019 Marzo | 0 | 5 | 5 |
| 2019 Febrero | 0 | 5 | 5 |
| 2019 Enero | 2 | 0 | 2 |
| 2018 Diciembre | 0 | 5 | 5 |
| 2018 Noviembre | 2 | 3 | 5 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Marzo | 1 | 0 | 1 |
| 2018 Febrero | 24 | 5 | 29 |
| 2018 Enero | 29 | 3 | 32 |
| 2017 Diciembre | 38 | 7 | 45 |
| 2017 Noviembre | 23 | 5 | 28 |
| 2017 Octubre | 33 | 14 | 47 |
| 2017 Septiembre | 12 | 2 | 14 |
| 2017 Agosto | 18 | 10 | 28 |
| 2017 Julio | 13 | 3 | 16 |
| 2017 Junio | 26 | 11 | 37 |
| 2017 Mayo | 23 | 9 | 32 |
| 2017 Abril | 27 | 13 | 40 |
| 2017 Marzo | 8 | 14 | 22 |
| 2017 Febrero | 16 | 6 | 22 |
| 2017 Enero | 12 | 7 | 19 |
| 2016 Diciembre | 25 | 15 | 40 |
| 2016 Noviembre | 30 | 12 | 42 |
| 2016 Octubre | 22 | 14 | 36 |
| 2016 Septiembre | 0 | 7 | 7 |
| 2016 Agosto | 0 | 2 | 2 |
| 2016 Julio | 9 | 1 | 10 |
| 2016 Junio | 23 | 1 | 24 |
| 2016 Mayo | 13 | 1 | 14 |
| 2016 Abril | 11 | 4 | 15 |
| 2016 Marzo | 8 | 2 | 10 |
| 2016 Febrero | 11 | 5 | 16 |
| 2016 Enero | 13 | 1 | 14 |
| 2015 Diciembre | 10 | 1 | 11 |
| 2015 Noviembre | 7 | 1 | 8 |
| 2015 Octubre | 6 | 0 | 6 |
| 2015 Septiembre | 10 | 1 | 11 |
| 2015 Agosto | 0 | 4 | 4 |
| 2015 Julio | 8 | 5 | 13 |
| 2015 Junio | 3 | 3 | 6 |
| 2015 Mayo | 2 | 2 | 4 |
| 2015 Abril | 0 | 5 | 5 |
| 2015 Marzo | 3 | 0 | 3 |
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