Case and Research Letter
Congenital Plaque-type Glomuvenous Malformation: 11 Years of Follow-up and Response to Treatment With the Combined Pulsed-Dye and Neodymium:Yttrium-Aluminum-Garnet Laser
Malformación glomovenosa congénita en placas: 11 años de seguimiento y respuesta al tratamiento con láser combinado PDL/Nd: YAG
N. Vargas-Navia
, E. Baselga, F.Z. Muñoz-Garza, L. Puig
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Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Vargas-Navia, E. Baselga, F.Z. Muñoz-Garza, L. Puig" "autores" => array:4 [ 0 => array:4 [ "nombre" => "N." "apellidos" => "Vargas-Navia" "email" => array:1 [ 0 => "navana2@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Baselga" ] 2 => array:2 [ "nombre" => "F.Z." "apellidos" => "Muñoz-Garza" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Puig" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Malformación glomovenosa congénita en placas: 11 años de seguimiento y respuesta al tratamiento con láser combinado PDL/Nd: YAG" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1802 "Ancho" => 1500 "Tamanyo" => 289708 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical course of the lesions. A, Newborn: erythematous-violaceous plaques on the back. B, At 6 months of age: plaques with prominent vessels, erythematous borders, and a blue-violaceous center. C, Before laser treatment (7 years of age). D, After 10 sessions of combined pulsed dye and neodymium-doped yttrium aluminium garnet laser treatment (11 years of age).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Glomuvenous malformations (GVM), previously known as glomangiomas, show a familial tendency and are characterized histologically by the presence of vascular channels surrounded by a variable number of glomus cells. There is a rare form that presents as plaques. The treatment of these lesions has still not been standardized.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Our patient was a newborn boy from a twin pregnancy, born preterm at 34 weeks, with erythematous plaques present on his back since birth. There was no family history of similar lesions. On physical examination, nonpulsatile, depressed erythematous-violaceous plaques were observed on the boy's back (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). We performed skin biopsy to clarify our differential diagnosis of capillary malformation, multiple myofibromas, or subcutaneous fat necrosis. Histopathology showed an increased number of ectatic vessels in the dermis and was interpreted as a capillary malformation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">At 6 months, the plaques had acquired an annular pattern, with an erythematous halo, depressed blue-violaceous center, ectatic vessels, and flaccid skin (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><p id="par0020" class="elsevierStylePara elsevierViewall">A further biopsy, performed because of the lack of clinical-pathological correlation, revealed a dermis with vascular structures surrounded by several layers of monomorphic round cells with eosinophilic cytoplasm (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Immunohistochemistry showed the perivascular glomus cells to be positive for vimentin and α-actin and negative for desmin and S100 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). Based on these findings, we made a diagnosis of congenital plaque-type GVM.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Initially we took a wait-and-see approach. Over the following years, the plaques extended to the adjacent skin and took on a more atrophic appearance, with very dilated vessels. No new lesions appeared.</p><p id="par0030" class="elsevierStylePara elsevierViewall">At 7 years of age, the lesions were still asymptomatic, but their appearance (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C) negatively affected the patient's self-esteem, leading us to evaluate the treatment options. The size of the lesions limited a possible surgical intervention. It was decided to start treatment with combined pulsed dye (PDL) (595<span class="elsevierStyleHsp" style=""></span>nm) and neodymium-doped yttrium aluminium garnet (Nd:YAG) (1064<span class="elsevierStyleHsp" style=""></span>nm) lasers (Cynergy Multiplex™, Cynosure, Westford, Massachusetts, United States), with a spot size of 10<span class="elsevierStyleHsp" style=""></span>mm, a PDL pulse duration of 0.5<span class="elsevierStyleHsp" style=""></span>ms and fluence of 8.5-9<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span>, followed by a pulse of Nd:YAG with a duration of 15<span class="elsevierStyleHsp" style=""></span>ms and fluence of 50<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span>. A cooling system was used simultaneously to prevent epidermal damage. The sessions were performed under general anesthesia every 2 or 3 months. The post-treatment recommendations included oral analgesia and photoprotection. At the time of writing, the patient has received 10 sessions of laser therapy, with lightening of the color of the lesions and a reduction in lesion volume and in the caliber of the vessels (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). Treatment has been well tolerated and no complications have been detected.</p><p id="par0035" class="elsevierStylePara elsevierViewall">GVMs account for 5% of venous malformations (VM) and are distinct from sporadic VMs and from hereditary mucocutaneous VMs. A familial tendency is detected in 88%, with an autosomal dominant inheritance pattern and incomplete penetrance (90%). Their etiology has been related to mutations in the glomulin gene (<span class="elsevierStyleItalic">GLMN</span>).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> GVMs are usually multiple and tend to appear at an early age. They can present as papular-nodular lesions or as plaques, and may be congenital<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> or acquired.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Congenital plaque-type GVMs present clinically as bluish plaques with a cobblestone surface,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> or as atrophic plaques with telangiectasias,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,4–9</span></a> as in our patient. A segmental distribution is often observed.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Histology is characterized by a nonencapsulated proliferation of ectatic vascular channels surrounded by 1 or several layers of polygonal glomus cells. Immunohistochemistry is positive for α-smooth muscle actin and vimentin and negative for desmin.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The clinical course of plaque-type GVMs varies. Progressive thickening and darkening of the lesions has been reported, as well as a tendency to spread into adjacent unaffected areas,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> as was seen in our patient.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The objectives of treatment of GVMs are to relieve pain and improve function and cosmetic appearance.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7,9</span></a> Surgery is an option for small localized lesions. Treatments such as sclerotherapy and ablative therapy have been used in multiple or extensive GVMs, but results have not been consistent.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> There are also descriptions of cases treated with Nd:YAG laser with good results,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> and PDL lasers have been reported to be useful for the more superficial component of the lesions.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> The dual laser (PDL/Nd:YAG) allows us to treat different depths of the skin using lower fluences and thus minimize the risk of scars or necrosis. There are 2 previous reports of congenital plaque-type GVM treated successfully with the combined PDL/Nd:YAG laser,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> using higher Nd:YAG fluences than those employed in our patient, with no complications (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">In conclusion, we have presented a case of congenital plaque-type GVM that, in its initial phases, was included in the series by Mallory et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> We draw attention to its uncommon clinical presentation, which was a diagnostic challenge and required histopathological confirmation, the atypical clinical course over 11 years, and the favorable response to combined laser treatment.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => 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: Vargas-Navia N, Baselga E, Muñoz-Garza FZ, Puig L. Malformación glomovenosa congénita en placas: 11 años de seguimiento y respuesta al tratamiento con láser combinado PDL/Nd: YAG. Actas Dermosifiliogr. 2017;108:72–74.</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" => 1802 "Ancho" => 1500 "Tamanyo" => 289708 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical course of the lesions. A, Newborn: erythematous-violaceous plaques on the back. B, At 6 months of age: plaques with prominent vessels, erythematous borders, and a blue-violaceous center. C, Before laser treatment (7 years of age). D, After 10 sessions of combined pulsed dye and neodymium-doped yttrium aluminium garnet laser treatment (11 years of age).</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" => 558 "Ancho" => 1500 "Tamanyo" => 191373 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathology. A, Blood vessels of different calibers surrounded by several layers of monomorphic round cells. Hematoxylin and eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×20). B, Positivity for α-smooth muscle actin. Immunohistochemistry, original magnification<span class="elsevierStyleHsp" style=""></span>×20.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "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"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age and Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Site Affected \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Fluence \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pulse Duration \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Spot Size \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. of Sessions \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Follow-up Period \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Response \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Complications \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34 y<br>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left arm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PDL 8<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span><br>Ns:YAG 70<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PDL: 0.5<span class="elsevierStyleHsp" style=""></span>ms<br>Ns:YAG: 15<span class="elsevierStyleHsp" style=""></span>ms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><br>10<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Resolution of the pain, lightening of color and volume reduction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 mo<br>Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Scalp, trunk, abdomen, back, right inguinal region and thighs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PDL: 6<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span><br>Ns:YAG: 110<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PDL: 0.5<span class="elsevierStyleHsp" style=""></span>ms<br>Ns:YAG: 20<span class="elsevierStyleHsp" style=""></span>ms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lightening of color and size reduction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Our patient \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 y<br>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Back \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PDL: 8.5<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">9</span><br>Ns:YAG: 50<span class="elsevierStyleHsp" style=""></span>J/cm<span class="elsevierStyleSup">9</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PDL: 0.5<span class="elsevierStyleHsp" style=""></span>ms<br>Ns:YAG: 15<span class="elsevierStyleHsp" style=""></span>ms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lightening of color and reduction of volume and of vessel caliber \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1302824.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patients With Congenital Plaque-Type Glomuvenous Malformations Treated With Combined Pulsed Dye and Neodymium-Doped Yttrium Aluminium Garnet Laser.</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" => "Glomuvenous malformation (glomangioma) and venous malformation: Distinct clinicopathologic and genetic entities" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.M. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 22 | 8 | 30 |
| 2024 Octubre | 97 | 41 | 138 |
| 2024 Septiembre | 96 | 21 | 117 |
| 2024 Agosto | 116 | 53 | 169 |
| 2024 Julio | 99 | 34 | 133 |
| 2024 Junio | 104 | 31 | 135 |
| 2024 Mayo | 114 | 23 | 137 |
| 2024 Abril | 104 | 23 | 127 |
| 2024 Marzo | 108 | 27 | 135 |
| 2024 Febrero | 86 | 25 | 111 |
| 2024 Enero | 88 | 32 | 120 |
| 2023 Diciembre | 100 | 30 | 130 |
| 2023 Noviembre | 110 | 25 | 135 |
| 2023 Octubre | 83 | 33 | 116 |
| 2023 Septiembre | 70 | 33 | 103 |
| 2023 Agosto | 58 | 21 | 79 |
| 2023 Julio | 54 | 48 | 102 |
| 2023 Junio | 58 | 30 | 88 |
| 2023 Mayo | 69 | 23 | 92 |
| 2023 Abril | 50 | 25 | 75 |
| 2023 Marzo | 75 | 29 | 104 |
| 2023 Febrero | 61 | 31 | 92 |
| 2023 Enero | 50 | 38 | 88 |
| 2022 Diciembre | 95 | 34 | 129 |
| 2022 Noviembre | 55 | 32 | 87 |
| 2022 Octubre | 93 | 22 | 115 |
| 2022 Septiembre | 40 | 31 | 71 |
| 2022 Agosto | 70 | 35 | 105 |
| 2022 Julio | 64 | 28 | 92 |
| 2022 Junio | 32 | 24 | 56 |
| 2022 Mayo | 36 | 27 | 63 |
| 2022 Abril | 53 | 36 | 89 |
| 2022 Marzo | 58 | 42 | 100 |
| 2022 Febrero | 56 | 38 | 94 |
| 2022 Enero | 56 | 37 | 93 |
| 2021 Diciembre | 40 | 33 | 73 |
| 2021 Noviembre | 54 | 53 | 107 |
| 2021 Octubre | 54 | 47 | 101 |
| 2021 Septiembre | 43 | 33 | 76 |
| 2021 Agosto | 47 | 33 | 80 |
| 2021 Julio | 64 | 35 | 99 |
| 2021 Junio | 53 | 38 | 91 |
| 2021 Mayo | 47 | 56 | 103 |
| 2021 Abril | 116 | 46 | 162 |
| 2021 Marzo | 70 | 39 | 109 |
| 2021 Febrero | 62 | 37 | 99 |
| 2021 Enero | 54 | 40 | 94 |
| 2020 Diciembre | 51 | 33 | 84 |
| 2020 Noviembre | 41 | 22 | 63 |
| 2020 Octubre | 32 | 13 | 45 |
| 2020 Septiembre | 43 | 27 | 70 |
| 2020 Agosto | 30 | 23 | 53 |
| 2020 Julio | 40 | 28 | 68 |
| 2020 Junio | 40 | 27 | 67 |
| 2020 Mayo | 23 | 11 | 34 |
| 2020 Abril | 26 | 13 | 39 |
| 2020 Marzo | 26 | 11 | 37 |
| 2020 Febrero | 8 | 0 | 8 |
| 2020 Enero | 1 | 0 | 1 |
| 2019 Diciembre | 5 | 0 | 5 |
| 2019 Septiembre | 6 | 0 | 6 |
| 2019 Junio | 9 | 0 | 9 |
| 2019 Mayo | 2 | 0 | 2 |
| 2019 Abril | 10 | 7 | 17 |
| 2019 Marzo | 1 | 0 | 1 |
| 2019 Febrero | 2 | 0 | 2 |
| 2019 Enero | 7 | 0 | 7 |
| 2018 Diciembre | 12 | 0 | 12 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 6 | 0 | 6 |
| 2018 Marzo | 0 | 1 | 1 |
| 2018 Febrero | 22 | 5 | 27 |
| 2018 Enero | 30 | 3 | 33 |
| 2017 Diciembre | 43 | 6 | 49 |
| 2017 Noviembre | 24 | 7 | 31 |
| 2017 Octubre | 27 | 9 | 36 |
| 2017 Septiembre | 24 | 6 | 30 |
| 2017 Agosto | 33 | 7 | 40 |
| 2017 Julio | 24 | 6 | 30 |
| 2017 Junio | 47 | 22 | 69 |
| 2017 Mayo | 27 | 14 | 41 |
| 2017 Abril | 27 | 14 | 41 |
| 2017 Marzo | 32 | 17 | 49 |
| 2017 Febrero | 53 | 36 | 89 |
| 2017 Enero | 47 | 28 | 75 |
| 2016 Diciembre | 5 | 20 | 25 |
| 2016 Noviembre | 0 | 1 | 1 |
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