Case for Diagnosis
Cutaneous Nodules in Multiple Myeloma
Nódulos cutáneos asociados a mieloma múltiple
Leído
6237
Vecesse ha leído el artículo
2040
Total PDF
4197
Total HTML
Compartir estadísticas
array:23 [ "pii" => "S1578219015001742" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.06.009" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "1144" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2014" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2015;106:581-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1121 "formatos" => array:3 [ "EPUB" => 58 "HTML" => 700 "PDF" => 363 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731015001283" "issn" => "00017310" "doi" => "10.1016/j.ad.2014.12.021" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "1144" "copyright" => "Elsevier España, S.L.U. y AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2015;106:581-2" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 992 "formatos" => array:3 [ "EPUB" => 2 "HTML" => 456 "PDF" => 534 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CASO PARA EL DIAGNÓSTICO</span>" "titulo" => "Nódulos cutáneos asociados a mieloma múltiple" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "581" "paginaFinal" => "582" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Cutaneous Nodules in Multiple Myeloma" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 732 "Ancho" => 976 "Tamanyo" => 256234 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Tinción inmunohistoquímica para IgG <span class="elsevierStyleItalic">kappa</span> (a) y <span class="elsevierStyleItalic">lambda</span> (b), ×20.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Gómez-Armayones, F. Climent, O. Servitje" "autores" => array:3 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Gómez-Armayones" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Climent" ] 2 => array:2 [ "nombre" => "O." "apellidos" => "Servitje" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219015001742" "doi" => "10.1016/j.adengl.2015.06.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015001742?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015001283?idApp=UINPBA000044" "url" => "/00017310/0000010600000007/v1_201509041239/S0001731015001283/v1_201509041239/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S1578219015001754" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.06.010" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "1084" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "article" "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2015;106:583-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 997 "formatos" => array:3 [ "EPUB" => 38 "HTML" => 544 "PDF" => 415 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Residents Forum</span>" "titulo" => "Weekend Ciclosporin Maintenance Therapy for Moderate Psoriasis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "583" "paginaFinal" => "584" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR-Terapia de mantenimiento con ciclosporina en pauta de fin de semana para psoriasis moderada" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Feltes, E. Macías del Toro, J.L. Ramírez Bellver, C. Bernardez Guerra" "autores" => array:4 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Feltes" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Macías del Toro" ] 2 => array:2 [ "nombre" => "J.L." "apellidos" => "Ramírez Bellver" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Bernardez Guerra" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731014004761" "doi" => "10.1016/j.ad.2014.10.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731014004761?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015001754?idApp=UINPBA000044" "url" => "/15782190/0000010600000007/v1_201508271313/S1578219015001754/v1_201508271313/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1578219015001729" "issn" => "15782190" "doi" => "10.1016/j.adengl.2015.06.007" "estado" => "S300" "fechaPublicacion" => "2015-09-01" "aid" => "1141" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2015;106:579-80" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1657 "formatos" => array:3 [ "EPUB" => 50 "HTML" => 594 "PDF" => 1013 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Cases for Diagnosis</span>" "titulo" => "Nodules on the Forehead Associated With Generalized Lymphadenopathy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "579" "paginaFinal" => "580" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nódulos frontales asociados a adenopatías generalizadas" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 921 "Ancho" => 950 "Tamanyo" => 199783 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Lobato-Berezo, F. Burgos-Lázaro, M.Á. Gallego-Valdés" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Lobato-Berezo" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Burgos-Lázaro" ] 2 => array:2 [ "nombre" => "M.Á." "apellidos" => "Gallego-Valdés" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015001258" "doi" => "10.1016/j.ad.2015.01.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015001258?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015001729?idApp=UINPBA000044" "url" => "/15782190/0000010600000007/v1_201508271313/S1578219015001729/v1_201508271313/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "Cutaneous Nodules in Multiple Myeloma" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "581" "paginaFinal" => "582" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Gómez-Armayones, F. Climent, O. Servitje" "autores" => array:3 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Gómez-Armayones" "email" => array:1 [ 0 => "sara.gomez.armayones@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" => "F." "apellidos" => "Climent" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "O." "apellidos" => "Servitje" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitari de Bellvitge, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitari de Bellvitge, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nódulos cutáneos asociados a mieloma múltiple" ] ] "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" => 732 "Ancho" => 976 "Tamanyo" => 254244 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemistry of IgG κ (A) and λ (B), original magnification, ×20.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">The patient was a 76-year-old woman with a history of systemic hypertension and IgA κ multiple myeloma (stage IIIB) diagnosed 1 year previously after an episode of acute renal failure. The patient also had Bence-Jones proteinuria, normocytic normochromic anemia, and lytic lesions in the axial skeleton, sternum, and pelvis. She had received several cycles of bortezomib and melphalan, although her disease continued to progress.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">The clinical manifestations comprised multiple erythematous nodules measuring between 0.5<span class="elsevierStyleHsp" style=""></span>cm and 3<span class="elsevierStyleHsp" style=""></span>cm in diameter that had first appeared on the left heel 2 months previously (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient reported associated pain. She also had severe macroglossia, although no significant lesions were visible on the rest of the skin or mucosas.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">Histopathology of the largest nodular lesion revealed a diffuse infiltrate of atypical cells throughout the dermis that were plasmablastic in appearance (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). These cells were positive for Ki-67, CD56, CD79a, CD138, cyclin DI, and IgG κ (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A) and negative for IgG λ (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">Although a radiograph of the affected limb was requested, the patient did not return to the clinic.</p><p id="par0025" class="elsevierStylePara elsevierViewall">What is your diagnosis?</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Cutaneous plasmacytoma associated with multiple myeloma.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Given the poor response to initial chemotherapy and the progression of the disease, no further therapy was prescribed. The biopsy did not rule out bone involvement contiguous to the skin lesions.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Skin involvement in multiple myeloma is very rare and generally occurs during the later stages of the disease.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> It was first described in 1910 by Bruno Bloch; to date, some 150 cases have been reported in the literature.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The 4 known neoplasms of plasma cells are classic multiple myeloma, extramedullary plasmacytoma without multiple myeloma, solitary plasmacytoma of bone, and plasma cell leukemia.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> All 4 types can affect the skin, although the most common mechanism is by direct extension to the skin from an underlying bone lesion; metastatic lesions without contiguous bone involvement are less likely.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Cutaneous plasmacytoma in the context of multiple myeloma is mainly associated with IgG and IgA.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Histopathology usually reveals a monomorphous dermal infiltrate of plasma cells with a diffuse interstitial or nodular pattern. Immunohistochemistry is usually positive for CD38, CD43, CD56, CD79a, CD138, epithelial membrane antigen, and κ and λ light chains.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The differential diagnosis includes diseases such as squamous cell carcinoma, skin metastases from internal neoplasms, cutaneous marginal zone lymphoma, cutaneous leishmaniasis, sarcoidosis, and amelanotic melanoma. However, the clinical setting of the patient should point us in the direction of plasmocytoma associated with multiple myeloma.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Treatment should be aimed at monoclonal gammopathy using autologous bone marrow transplant in persons aged less than 65 years and chemotherapy with bortezomib and melphalan, combined with local radiation therapy and surgical removal of the skin lesion where necessary.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Additional Tests" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical Course and Treatment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gómez-Armayones S, Climent F, Servitje O. Nódulos cutáneos asociados a mieloma múltiple. Actas Dermosifiliogr. 2015;106:581–582.</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" => 434 "Ancho" => 650 "Tamanyo" => 71055 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical image.</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" => 488 "Ancho" => 650 "Tamanyo" => 173570 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification, ×20.</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" => 732 "Ancho" => 976 "Tamanyo" => 254244 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemistry of IgG κ (A) and λ (B), original magnification, ×20.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous involvement in multiple myeloma: A clinicopathologic, immunohistochemical, and cytogenetic study of 8 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Requena" 1 => "H. Kutzner" 2 => "G. Palmedo" 3 => "E. Calonje" 4 => "C. Requena" 5 => "G. Pérez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archderm.139.4.475" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "2003" "volumen" => "139" "paginaInicial" => "475" "paginaFinal" => "486" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12707095" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metastatic cutaneous plasmacytoma: A case report associated with IgA lambda multiple myeloma and a review of the literature of metastatic cutaneous plasmacytomas associated with multiple myeloma and primary cutaneous plasmacytomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Kato" 1 => "K. Kimura" 2 => "K. Yasukawa" 3 => "K. Aikawa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Dermatol." "fecha" => "1999" "volumen" => "26" "paginaInicial" => "587" "paginaFinal" => "594" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10535253" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Afectación cutánea específica en pacientes con mieloma múltiple. Estudio clínico-patológico, inmunohistoquímico y citogenético de 40 casos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Requena" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr." "fecha" => "2005" "volumen" => "96" "paginaInicial" => "424" "paginaFinal" => "440" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16476270" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous nodules as a diagnostic clue in multiple myeloma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Ballester-Martínez" 1 => "C. González-García" 2 => "B. Fleta-Asín" 3 => "A. Burdaspal-Moratilla" 4 => "A. Santón-Roldán" 5 => "N. Jiménez-Gómez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DAD.0b013e3182726e79" "Revista" => array:6 [ "tituloSerie" => "Am J Dermatopathol." "fecha" => "2013" "volumen" => "35" "paginaInicial" => "377" "paginaFinal" => "380" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23095339" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Case for diagnosis. Cutaneous involvement associated to multiple myeloma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Santos" 1 => "L. Sousa" 2 => "T. Fernandes" 3 => "A. João" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/abd1806-4841.20142431" "Revista" => array:6 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2014" "volumen" => "89" "paginaInicial" => "173" "paginaFinal" => "174" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24626671" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010600000007/v1_201508271313/S1578219015001742/v1_201508271313/en/main.assets" "Apartado" => array:4 [ "identificador" => "6154" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010600000007/v1_201508271313/S1578219015001742/v1_201508271313/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015001742?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 9 | 11 | 20 |
| 2024 Octubre | 85 | 39 | 124 |
| 2024 Septiembre | 119 | 19 | 138 |
| 2024 Agosto | 145 | 60 | 205 |
| 2024 Julio | 134 | 34 | 168 |
| 2024 Junio | 124 | 26 | 150 |
| 2024 Mayo | 107 | 31 | 138 |
| 2024 Abril | 103 | 29 | 132 |
| 2024 Marzo | 132 | 22 | 154 |
| 2024 Febrero | 125 | 40 | 165 |
| 2024 Enero | 135 | 30 | 165 |
| 2023 Diciembre | 93 | 21 | 114 |
| 2023 Noviembre | 113 | 28 | 141 |
| 2023 Octubre | 122 | 33 | 155 |
| 2023 Septiembre | 93 | 34 | 127 |
| 2023 Agosto | 79 | 16 | 95 |
| 2023 Julio | 100 | 34 | 134 |
| 2023 Junio | 55 | 25 | 80 |
| 2023 Mayo | 75 | 23 | 98 |
| 2023 Abril | 32 | 21 | 53 |
| 2023 Marzo | 49 | 23 | 72 |
| 2023 Febrero | 60 | 22 | 82 |
| 2023 Enero | 46 | 27 | 73 |
| 2022 Diciembre | 56 | 44 | 100 |
| 2022 Noviembre | 40 | 41 | 81 |
| 2022 Octubre | 29 | 22 | 51 |
| 2022 Septiembre | 35 | 33 | 68 |
| 2022 Agosto | 25 | 31 | 56 |
| 2022 Julio | 29 | 39 | 68 |
| 2022 Junio | 32 | 30 | 62 |
| 2022 Mayo | 41 | 35 | 76 |
| 2022 Abril | 75 | 46 | 121 |
| 2022 Marzo | 53 | 50 | 103 |
| 2022 Febrero | 40 | 40 | 80 |
| 2022 Enero | 78 | 36 | 114 |
| 2021 Diciembre | 37 | 37 | 74 |
| 2021 Noviembre | 38 | 50 | 88 |
| 2021 Octubre | 56 | 50 | 106 |
| 2021 Septiembre | 56 | 30 | 86 |
| 2021 Agosto | 48 | 33 | 81 |
| 2021 Julio | 43 | 35 | 78 |
| 2021 Junio | 45 | 31 | 76 |
| 2021 Mayo | 55 | 19 | 74 |
| 2021 Abril | 75 | 38 | 113 |
| 2021 Marzo | 53 | 20 | 73 |
| 2021 Febrero | 63 | 31 | 94 |
| 2021 Enero | 38 | 13 | 51 |
| 2020 Diciembre | 26 | 23 | 49 |
| 2020 Noviembre | 23 | 22 | 45 |
| 2020 Octubre | 14 | 9 | 23 |
| 2020 Septiembre | 26 | 11 | 37 |
| 2020 Agosto | 20 | 20 | 40 |
| 2020 Julio | 23 | 18 | 41 |
| 2020 Junio | 23 | 29 | 52 |
| 2020 Mayo | 22 | 15 | 37 |
| 2020 Abril | 23 | 18 | 41 |
| 2020 Marzo | 19 | 28 | 47 |
| 2020 Febrero | 5 | 2 | 7 |
| 2020 Enero | 0 | 4 | 4 |
| 2019 Diciembre | 1 | 2 | 3 |
| 2019 Noviembre | 0 | 1 | 1 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 4 | 3 | 7 |
| 2019 Agosto | 0 | 1 | 1 |
| 2019 Julio | 0 | 8 | 8 |
| 2019 Junio | 0 | 20 | 20 |
| 2019 Mayo | 2 | 54 | 56 |
| 2019 Abril | 1 | 31 | 32 |
| 2019 Marzo | 2 | 5 | 7 |
| 2019 Febrero | 2 | 7 | 9 |
| 2019 Enero | 0 | 3 | 3 |
| 2018 Diciembre | 5 | 6 | 11 |
| 2018 Noviembre | 9 | 3 | 12 |
| 2018 Octubre | 12 | 0 | 12 |
| 2018 Septiembre | 8 | 0 | 8 |
| 2018 Agosto | 0 | 11 | 11 |
| 2018 Julio | 0 | 3 | 3 |
| 2018 Junio | 0 | 4 | 4 |
| 2018 Mayo | 0 | 4 | 4 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Marzo | 0 | 2 | 2 |
| 2018 Febrero | 97 | 3 | 100 |
| 2018 Enero | 70 | 5 | 75 |
| 2017 Diciembre | 88 | 6 | 94 |
| 2017 Noviembre | 32 | 4 | 36 |
| 2017 Octubre | 29 | 5 | 34 |
| 2017 Septiembre | 15 | 4 | 19 |
| 2017 Agosto | 27 | 5 | 32 |
| 2017 Julio | 26 | 9 | 35 |
| 2017 Junio | 28 | 5 | 33 |
| 2017 Mayo | 31 | 5 | 36 |
| 2017 Abril | 25 | 15 | 40 |
| 2017 Marzo | 19 | 7 | 26 |
| 2017 Febrero | 13 | 11 | 24 |
| 2017 Enero | 22 | 7 | 29 |
| 2016 Diciembre | 34 | 28 | 62 |
| 2016 Noviembre | 38 | 21 | 59 |
| 2016 Octubre | 32 | 19 | 51 |
| 2016 Septiembre | 0 | 5 | 5 |
| 2016 Agosto | 0 | 1 | 1 |
| 2016 Julio | 5 | 2 | 7 |
| 2016 Junio | 8 | 3 | 11 |
| 2016 Mayo | 9 | 2 | 11 |
| 2016 Abril | 0 | 9 | 9 |
| 2016 Marzo | 4 | 0 | 4 |
| 2016 Febrero | 0 | 1 | 1 |
| 2016 Enero | 0 | 2 | 2 |
| 2015 Noviembre | 0 | 2 | 2 |
| 2015 Octubre | 0 | 3 | 3 |
Mostrar todo
