Case and Research Letter
Non-AIDS Kaposi sarcoma in the external ear
Sarcoma de Kaposi del oído externo, no asociado con SIDA
L. Francés Rodrígueza,
, A. Bouret Lebróna, C. Muñoz Ruízb, J. Bañuls Rocaa,c
Autor para correspondencia
a Dermatology Department, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (Isabial), Alicante, Spain
b Immunology Department, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (Isabial), Alicante, Spain
c Medicina Clinica Department, Dermatology Area, Miguel Hernández University, Sant Joan D’Alacant, Alicante, Spain
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"apellidos" => "Bañuls Roca" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Dermatology Department, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (Isabial), Alicante, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Immunology Department, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (Isabial), Alicante, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Medicina Clinica Department, Dermatology Area, Miguel Hernández University, Sant Joan D’Alacant, Alicante, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sarcoma de Kaposi del oído externo, no asociado con SIDA" ] ] "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" => 1148 "Ancho" => 1500 "Tamanyo" => 215760 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Polypoid lesion of the right ear.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Kaposi sarcoma (KS) is an uncommon, malignant, multifocal systemic disease derived from the proliferation of endothelial cells. The disease has predominant cutaneous involvement and follows a benign course, but in severe cases it can affect other organs, especially the gastrointestinal tract and the lungs. In 1994, Chang et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> demonstrated that human herpesvirus type 8 (HHV-8) infection is involved in the etiology of KS. Its presence has been detected in over 90% of biological tissues affected, and it is now considered a valuable diagnostic marker of the disease. Classic KS (described in 1872 by Moritz Kaposi) is the most common form of KS, and it usually affects elderly males of Eastern European or Mediterranean origin. Clinically, it manifests as red-bluish papules, plaques, and nodules on the lower extremities that exhibit a slow but steady growth. There are 4 types of KS: classic KS, endemic (African) KS, immunocompromised (iatrogenic) KS (related to aggressive immunosuppressive treatment), and AIDS-related (epidemic) KS. A new variant related to homosexuality was recently described in men who have sex with men: non-human immunodeficiency virus (HIV)-associated KS.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We describe a rare presentation of KS of the external ear in an immunocompetent patient. A 77-year-old woman came to our dermatology department with a firm, slow-growing, red-bluish nodule measuring 1.4<span class="elsevierStyleHsp" style=""></span>cm in diameter on the anterior helix of the right pinna (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). She was otherwise well and had no relevant past history of skin disorders, other medical conditions, or associated immunosuppression. The tumor was painless, and there was no bleeding or lymphadenopathy. It had a vascular appearance, and the tentative diagnosis was pyogenic granuloma, although other diagnoses considered were amelanotic melanoma, epidermoid carcinoma, Merkel cell carcinoma, and atypical fibroxanthoma. The lesion was excised completely, and histologic examination revealed a proliferation of fine, irregular vascular channels, with erythrocyte extravasation and minimal pleomorphism and mitotic activity (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Positive staining of spindle cells with CD31, CD34, and HHV-8 was consistent with a diagnosis of KS (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Laboratory tests only revealed hyperglycemia. Serology and polymerase chain reaction results were both positive for HHV-8. Serology for HIV, cytomegalovirus, herpes zoster virus, Epstein–Barr virus, HHV-6, and HHV-7 was negative. To rule out gastrointestinal disease, we performed a fecal occult blood test and an endoscopy, but observed no pathological findings. A whole-body computed tomography scan showed no other visceral disease. Screening laboratory tests to evaluate cellular immunity (total lymphocyte count, T-cell, B-cell, and natural killer-cell enumeration using flow cytometry) and functional assessment of helper T (T<span class="elsevierStyleInf">H</span>) cells based on T<span class="elsevierStyleInf">H</span>1 and T<span class="elsevierStyleInf">H</span>2 cytokine production were normal, but early response to stimulation measured by detection of intracellular adenosine triphosphate (ATP) synthesis in T cells (Immuknow, Viracor IBT Laboratories Inc.) was low. This suggested defective T-cell activation because the production of intracellular ATP is one of the first steps in cellular activation. During 2 years of follow-up, no recurrences, new lesions, or new immunosuppressive diseases have been detected.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The head is a common site for multiple lesions in HIV patients with KS. However, the presence of a solitary lesion on the ear of an immunocompetent patient is a very rare finding, and very few cases of KS have been reported on the pinna in patients without a history of immunodeficiency (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Like our patient, most of the patients described in the literature are elderly, with the exception of a healthy 36-year-old white man. We do not know why certain vascular proliferations, such as angiolymphoid hyperplasia with eosinophilia, have a special predilection for the pinna, but we hypothesize that the sum of certain traumatic/infectious factors in an acral area with complex, fine, and insufficient vascularization could make access difficult for immune cells. All these conditions could favor the occurrence of these vascular tumors in certain individuals with immune dysfunction that has not been adequately studied. We highlight the importance of contemplating KS in the differential diagnosis of tumors with a vascular appearance involving the ears in immunologically competent individuals.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1148 "Ancho" => 1500 "Tamanyo" => 215760 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Polypoid lesion of the right ear.</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" => 1241 "Ancho" => 1659 "Tamanyo" => 827822 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Proliferation of fine, irregular vascular channels, with erythrocyte extravasation (hematoxylin–eosin staining, 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" => 1234 "Ancho" => 1650 "Tamanyo" => 741404 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Nuclear positivity for human herpes virus 8 (hematoxylin–eosin staining, original magnification ×20).</p>" ] ] 3 => 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:2 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">EBV, Epstein–Barr virus; HHV, human herpes virus; HIV, human immunodeficiency virus; ND, not determinated.</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"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Author(s) \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">Year \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, y \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">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">Geographic/ethnic origin \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 lesions/location \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">HIV \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">HHV-8 \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">Naunton and Stoller<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1960 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">North American \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/Right helix<br>1/Lip \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ND \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">Gibbs<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1968 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">North-American \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Multiple nodules on each ear<br>1/Left foot \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ND \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">Stearns et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1983 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Indian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/Left external auditory meatus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ND \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">Babuccu et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">White \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/Left pinna \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HIV<span class="elsevierStyleSup">−</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HHV-8<span class="elsevierStyleSup">+</span> \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">Colletti et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">White \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/Right pinna \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HIV<span class="elsevierStyleSup">−</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HHV-8<span class="elsevierStyleSup">+</span> \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">Izquierdo Cuenca et al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">White \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/Right pinna \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HIV<span class="elsevierStyleSup">−</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HHV-8<span class="elsevierStyleSup">+</span> \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">Busi et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">White \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/Right right pinna and external auditory canal<br>Multiple lesions on right arm and left leg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HIV<span class="elsevierStyleSup">−</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HHV-8<span class="elsevierStyleSup">+</span> (also HHV-4<span class="elsevierStyleSup">+</span> and EBV<span class="elsevierStyleSup">+</span>) \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 case \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">White \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/Right pinna \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HIV<span class="elsevierStyleSup">−</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HHV-8<span class="elsevierStyleSup">+</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1260385.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Cases of Kaposi sarcoma involving the external ear of patients without AIDS.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Twenty years of KSHV" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y. 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| 2023 Febrero | 52 | 25 | 77 |
| 2023 Enero | 36 | 26 | 62 |
| 2022 Diciembre | 57 | 35 | 92 |
| 2022 Noviembre | 31 | 24 | 55 |
| 2022 Octubre | 34 | 19 | 53 |
| 2022 Septiembre | 27 | 36 | 63 |
| 2022 Agosto | 24 | 26 | 50 |
| 2022 Julio | 18 | 29 | 47 |
| 2022 Junio | 30 | 19 | 49 |
| 2022 Mayo | 65 | 24 | 89 |
| 2022 Abril | 77 | 22 | 99 |
| 2022 Marzo | 60 | 38 | 98 |
| 2022 Febrero | 78 | 21 | 99 |
| 2022 Enero | 90 | 31 | 121 |
| 2021 Diciembre | 44 | 32 | 76 |
| 2021 Noviembre | 58 | 39 | 97 |
| 2021 Octubre | 63 | 56 | 119 |
| 2021 Septiembre | 67 | 37 | 104 |
| 2021 Agosto | 115 | 25 | 140 |
| 2021 Julio | 85 | 23 | 108 |
| 2021 Junio | 123 | 26 | 149 |
| 2021 Mayo | 93 | 33 | 126 |
| 2021 Abril | 317 | 46 | 363 |
| 2021 Marzo | 102 | 23 | 125 |
| 2021 Febrero | 100 | 19 | 119 |
| 2021 Enero | 78 | 15 | 93 |
| 2020 Diciembre | 49 | 14 | 63 |
| 2020 Noviembre | 46 | 18 | 64 |
| 2020 Octubre | 43 | 8 | 51 |
| 2020 Septiembre | 30 | 12 | 42 |
| 2020 Agosto | 19 | 11 | 30 |
| 2020 Julio | 20 | 13 | 33 |
| 2020 Junio | 24 | 25 | 49 |
| 2020 Mayo | 17 | 9 | 26 |
| 2020 Abril | 20 | 15 | 35 |
| 2020 Marzo | 21 | 11 | 32 |
| 2020 Febrero | 6 | 3 | 9 |
| 2020 Enero | 4 | 0 | 4 |
| 2019 Diciembre | 4 | 0 | 4 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 3 | 0 | 3 |
| 2019 Mayo | 5 | 0 | 5 |
| 2019 Abril | 2 | 3 | 5 |
| 2019 Marzo | 2 | 0 | 2 |
| 2019 Febrero | 6 | 0 | 6 |
| 2019 Enero | 3 | 0 | 3 |
| 2018 Diciembre | 3 | 0 | 3 |
| 2018 Noviembre | 3 | 0 | 3 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Febrero | 16 | 4 | 20 |
| 2018 Enero | 37 | 10 | 47 |
| 2017 Diciembre | 34 | 6 | 40 |
| 2017 Noviembre | 30 | 8 | 38 |
| 2017 Octubre | 23 | 6 | 29 |
| 2017 Septiembre | 17 | 7 | 24 |
| 2017 Agosto | 21 | 7 | 28 |
| 2017 Julio | 13 | 5 | 18 |
| 2017 Junio | 22 | 11 | 33 |
| 2017 Mayo | 25 | 7 | 32 |
| 2017 Abril | 25 | 13 | 38 |
| 2017 Marzo | 14 | 13 | 27 |
| 2017 Febrero | 18 | 8 | 26 |
| 2017 Enero | 7 | 11 | 18 |
| 2016 Diciembre | 49 | 26 | 75 |
| 2016 Noviembre | 13 | 8 | 21 |
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