Case for Diagnosis
Pitting Edema of the Face, An Important Differential Diagnosis
Edema facial con fóvea, un importante diagnóstico diferencial
Leído
22002
Vecesse ha leído el artículo
2051
Total PDF
19951
Total HTML
Compartir estadísticas
array:25 [ "pii" => "S1578219019303427" "issn" => "15782190" "doi" => "10.1016/j.adengl.2019.11.001" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "2237" "copyright" => "AEDV" "copyrightAnyo" => "2019" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2020;111:65-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0001731019302236" "issn" => "00017310" "doi" => "10.1016/j.ad.2018.04.018" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "2237" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2020;111:65-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 84 "formatos" => array:2 [ "HTML" => 63 "PDF" => 21 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Casos para el diagnóstico</span>" "titulo" => "Edema facial con fóvea, un importante diagnóstico diferencial" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "65" "paginaFinal" => "66" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pitting Edema of the Face, An Important Differential Diagnosis" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 749 "Ancho" => 500 "Tamanyo" => 71282 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Edema facial con fóvea y eritema predominantemente en la hemicara izquierda.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.G. Chalela, M.I. González, M.F. Ordóñez Rubiano" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J.G." "apellidos" => "Chalela" ] 1 => array:2 [ "nombre" => "M.I." "apellidos" => "González" ] 2 => array:2 [ "nombre" => "M.F." "apellidos" => "Ordóñez Rubiano" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219019303427" "doi" => "10.1016/j.adengl.2019.11.001" "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/S1578219019303427?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731019302236?idApp=UINPBA000044" "url" => "/00017310/0000011100000001/v3_202009190630/S0001731019302236/v3_202009190630/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S1578219019303506" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.06.030" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "2216" "copyright" => "AEDV" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Actas Dermosifiliogr. 2020;111:67-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Resident’s Forum</span>" "titulo" => "Vaccine for the Prevention of Herpes Zoster" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "67" "paginaFinal" => "68" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR-Nueva vacuna recombinante para la prevención del herpes zóster" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Morgado-Carrasco, X. Fustà-Novell, P. Giavedoni" "autores" => array:3 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Morgado-Carrasco" ] 1 => array:2 [ "nombre" => "X." "apellidos" => "Fustà-Novell" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Giavedoni" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731019301814" "doi" => "10.1016/j.ad.2018.06.020" "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/S0001731019301814?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019303506?idApp=UINPBA000044" "url" => "/15782190/0000011100000001/v2_202004200619/S1578219019303506/v2_202004200619/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S1578219019302471" "issn" => "15782190" "doi" => "10.1016/j.adengl.2019.07.017" "estado" => "S300" "fechaPublicacion" => "2020-01-01" "aid" => "2179" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2020;111:63-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3 "formatos" => array:2 [ "HTML" => 1 "PDF" => 2 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "Recurrent Buttock Cellulitis in a Young Man" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "63" "paginaFinal" => "64" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Celulitis glútea de repetición en un varón joven" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 645 "Ancho" => 900 "Tamanyo" => 135755 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin–eosin, ×200.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Morgado-Carrasco, P. Giavedoni, J.M. Mascaró" "autores" => array:3 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Morgado-Carrasco" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Giavedoni" ] 2 => array:2 [ "nombre" => "J.M." "apellidos" => "Mascaró" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731019301139" "doi" => "10.1016/j.ad.2018.06.018" "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/S0001731019301139?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019302471?idApp=UINPBA000044" "url" => "/15782190/0000011100000001/v2_202004200619/S1578219019302471/v2_202004200619/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "Pitting Edema of the Face, An Important Differential Diagnosis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "65" "paginaFinal" => "66" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.G. Chalela, M.I. González, M.F. Ordóñez Rubiano" "autores" => array:3 [ 0 => array:3 [ "nombre" => "J.G." "apellidos" => "Chalela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "M.I." "apellidos" => "González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "M.F." "apellidos" => "Ordóñez Rubiano" "email" => array:1 [ 0 => "Mfordonezr@Gmail.Com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Dermatología, Hospital Universitario Fundación Santa Fe, Bogotá, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Anatomía Patológica, Universidad Militar Nueva Granada, Bogotá, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Dermatología, Universidad Militar Nueva Granada, Bogotá, Colombia" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Edema facial con fóvea, un importante diagnóstico diferencial" ] ] "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" => 755 "Ancho" => 506 "Tamanyo" => 67906 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Facial pitting erythematous edema, predominantly on the left side.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">CASE PRESENTATION</span><p id="par0005" class="elsevierStylePara elsevierViewall">A man in his 80s presented with a 7-month history of progressive facial swelling that started in the cheeks and extended to the eyelids and then to the whole face, predominantly on the left side. He had not received treatment for his current complaint. The patient had a history of type 2 diabetes controlled with metformin, and a slightly elevated prostate-specific antigen, with no history of other dermatological conditions.</p><p id="par0010" class="elsevierStylePara elsevierViewall">On physical examination, solid, pitting edema involving his entire face (including eyelids and partially the scalp) associated with erythema was observed (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). There were no other lesions in the total skin examination and the rest of the physical exam was unremarkable. A biopsy specimen from his cheek was obtained where a poorly circumscribed dermal tumor extending into the subcutaneous tissue composed of thin vessels lined by prominent endothelial cells exhibiting cellular atypia and proliferation on the luminal side. The dilated vessels extended between dermal collagen bundles and were accompanied by inflammatory cells, predominantly small lymphocytes and plasmocytes.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Immunohistochemistry markers were positive for CD31, FLI1, CD34 and D240 on the lining endothelial cells of the dilated vessels, with a proliferation index (Ki67) of 70%. HHV-8 was negative. (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">DIAGNOSIS</span><p id="par0020" class="elsevierStylePara elsevierViewall">Idiopathic angiosarcoma</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">DISCUSSION</span><p id="par0025" class="elsevierStylePara elsevierViewall">Idiopathic angiosarcoma of the head and neck (IAHN) is one of the three main clinicopathological subtypes (angiosarcoma complicating lymphedema and postirradiation angiosarcoma) described in 1987.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,2</span></a> This type of angiosarcoma commonly involves the upper part of the face or the scalp of elderly men.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> The lesions may be single or multifocal, violaceous nodules, plaques or macules representing infiltrating areas, usually they become markedly more violaceous and bloated when the head-tilt maneuver is performed (placing the head below the level of the heart).<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,4</span></a> The size usually ranges between 0.8 – 8<span class="elsevierStyleHsp" style=""></span>cms but larger tumors have been recorded.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">There have been other clinical presentations of IAHN including recurrent angioedema of the face, a rosacea-like eruption, rhinophyma-like eruption or an inflammatory process.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> IAHN presenting as persistent swelling of the face has been reported and,<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">5–7</span></a> even thought it is rare, it is an important differential diagnosis of this acquired syndrome that includes infectious (leprosy, tuberculosis, lymphedema secondary to herpes infection), inflammatory (rosacea, Morbihan disease, acne, Melkersson-Rosenthal syndrome, angioedema), neoplastic (cutaneous lymphomas, metastases) and miscellaneous disorders (amyloidosis, scleromyxedema, Wells syndrome, pseudolymphoma, post-operative and post-radiotherapy states).<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Clinical suspicion must be confirmed with histopathology and immunohistochemistry.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> Histopathology is similar in all the types of angiosarcoma, and is highly variable depending on its differentiation.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> They are characterized by irregular, meshwork of anastomosing dilated vessels that dissect dermal collagen bundles and skin appendages usually involving the deep subcutaneous tissue.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> The lining endothelial cells appear hyperchromatic and pleomorphic that usually protrudes into vascular lumina. Immunohistochemical markers are of vascular origin, cytoplasmic CD31 and CD34 are the most frequently used for diagnosis, for a more sensitive diagnosis other nuclear inmunohistochemical markers such as ERG and FLI1 may be used.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Additionally, D2-40 and VEGFR-3, lymphatic markers are expressed.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Currently, surgery (3<span class="elsevierStyleHsp" style=""></span>cm margins) with subsequent radiotherapy is the mainstay of treatment.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,3</span></a> Regarding chemotherapy, studies are inconsistent, paclitaxel and doxorubicin-based regimens are considered the best choice.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,4</span></a> New targeted cancer therapies (tyrosine kinase-pazopanib, sorafenib- and VEGF inhibitors-Bevacizumab-) have been used for angiosarcoma but the studies have shown conflicting results.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,4</span></a> Treatment of facial swelling IAHN is extrapolated from studies of other frequent variants, but surgery is not an option given the difficulty of the approach.</p><p id="par0045" class="elsevierStylePara elsevierViewall">It is important to consider IAHN as a differential diagnosis of solid progressive pitting edema of the face as it alters the patient's life prognosis due to ineffective and poorly studied treatment options. Our patient is currently treated with radiotherapy, with no progression of the disease after 6 months. Upcoming studies regarding new targeted cancer therapies may change its prognosis, even in extensive and highly proliferative disease such as in the case of our patient.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "CASE PRESENTATION" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "DIAGNOSIS" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "DISCUSSION" ] 3 => array:1 [ "titulo" => "Références" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-02-14" "fechaAceptado" => "2018-04-16" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Chalela JG, González MI, Ordóñez Rubiano MF. Edema facial con fóvea, un importante diagnóstico diferencial. Actas Dermosifiliogr. 2020;111:65–66.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 755 "Ancho" => 506 "Tamanyo" => 67906 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Facial pitting erythematous edema, predominantly on the left side.</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" => 733 "Ancho" => 756 "Tamanyo" => 214821 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A. Panoramic view of the tumor extending through the dermis. B. The tumor composed of thin vessels lined by prominent endothelial cells exhibiting cellular atypia on the luminal side. C-D Immunohistochemistry showing vascular and endothelial differentiation, also high proliferation index.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Références" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous angiosarcoma: A current update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Shustef" 1 => "V. Kazlouskaya" 2 => "V.G. Prieto" 3 => "D. Ivan" 4 => "P.P. Aung" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/jclinpath-2017-204601" "Revista" => array:6 [ "tituloSerie" => "J Clin Pathol" "fecha" => "2017" "volumen" => "70" "paginaInicial" => "917" "paginaFinal" => "925" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28916596" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0050" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Angiosarcoma of the face and scalp, prognosis.and treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.A. Holden" 1 => "M.F. Spittle" 2 => "E.W. Jones" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/1097-0142(19870301)59:5<1046::aid-cncr2820590533>3.0.co;2-6" "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "1987" "volumen" => "59" "paginaInicial" => "1046" "paginaFinal" => "1057" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3815265" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0055" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous angiosarcoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.A. Dossett" 1 => "M. Harrington" 2 => "C.W. Cruse" 3 => "R.J. Gonzalez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.currproblcancer.2015.07.007" "Revista" => array:6 [ "tituloSerie" => "Curr Probl Cancer" "fecha" => "2015" "volumen" => "39" "paginaInicial" => "258" "paginaFinal" => "263" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26276214" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0060" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malignant neoplasms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "O.P. Sangueza" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:6 [ "editores" => "O.P.Sangueza, L.Requena" "titulo" => "Pathology of vascular skin lesions: Clinicopathologic Correlations" "paginaInicial" => "251" "paginaFinal" => "255" "edicion" => "1st edition" "serieFecha" => "2003" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0065" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous angiosarcoma clinically presenting as progressive solid facial edema in a 43-year-old male" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "W.T. Choi" 1 => "G.Y. Stetsenko" 2 => "J. Zhang" 3 => "J.E. Olerud" 4 => "Z.B. Argenyi" 5 => "E. George" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatol Online J" "fecha" => "2013" "volumen" => "19" "paginaInicial" => "20409" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24314784" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0070" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Angiosarcoma of the face" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "I.J. Mackenzie" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1985" "volumen" => "121" "paginaInicial" => "549" "paginaFinal" => "550" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4038865" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0075" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous angiosarcoma presenting as recurrent angio-oedema of the face" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y.K. Tay" 1 => "B.H. Ong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1365-2133.2000.03933.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2000" "volumen" => "143" "paginaInicial" => "1346" "paginaFinal" => "1348" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11122065" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0080" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Persistent facial erythema and edema" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Utikal" 1 => "N. Poenitz" 2 => "H. Kurzen" 3 => "S. Goerdt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Dtsch Dermatol Ges" "fecha" => "2005" "volumen" => "3" "paginaInicial" => "467" "paginaFinal" => "469" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011100000001/v2_202004200619/S1578219019303427/v2_202004200619/en/main.assets" "Apartado" => array:4 [ "identificador" => "6171" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cases for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011100000001/v2_202004200619/S1578219019303427/v2_202004200619/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019303427?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 37 | 3 | 40 |
| 2024 Octubre | 340 | 58 | 398 |
| 2024 Septiembre | 368 | 28 | 396 |
| 2024 Agosto | 405 | 66 | 471 |
| 2024 Julio | 514 | 43 | 557 |
| 2024 Junio | 387 | 43 | 430 |
| 2024 Mayo | 312 | 33 | 345 |
| 2024 Abril | 318 | 33 | 351 |
| 2024 Marzo | 391 | 35 | 426 |
| 2024 Febrero | 394 | 44 | 438 |
| 2024 Enero | 413 | 36 | 449 |
| 2023 Diciembre | 419 | 30 | 449 |
| 2023 Noviembre | 576 | 33 | 609 |
| 2023 Octubre | 569 | 18 | 587 |
| 2023 Septiembre | 474 | 30 | 504 |
| 2023 Agosto | 437 | 21 | 458 |
| 2023 Julio | 519 | 44 | 563 |
| 2023 Junio | 500 | 32 | 532 |
| 2023 Mayo | 667 | 42 | 709 |
| 2023 Abril | 523 | 23 | 546 |
| 2023 Marzo | 587 | 34 | 621 |
| 2023 Febrero | 402 | 34 | 436 |
| 2023 Enero | 447 | 39 | 486 |
| 2022 Diciembre | 320 | 45 | 365 |
| 2022 Noviembre | 324 | 33 | 357 |
| 2022 Octubre | 269 | 25 | 294 |
| 2022 Septiembre | 235 | 35 | 270 |
| 2022 Agosto | 278 | 36 | 314 |
| 2022 Julio | 211 | 44 | 255 |
| 2022 Junio | 99 | 43 | 142 |
| 2022 Mayo | 307 | 56 | 363 |
| 2022 Abril | 397 | 36 | 433 |
| 2022 Marzo | 417 | 62 | 479 |
| 2022 Febrero | 477 | 48 | 525 |
| 2022 Enero | 491 | 60 | 551 |
| 2021 Diciembre | 393 | 52 | 445 |
| 2021 Noviembre | 350 | 38 | 388 |
| 2021 Octubre | 415 | 56 | 471 |
| 2021 Septiembre | 319 | 38 | 357 |
| 2021 Agosto | 346 | 29 | 375 |
| 2021 Julio | 362 | 25 | 387 |
| 2021 Junio | 668 | 64 | 732 |
| 2021 Mayo | 424 | 55 | 479 |
| 2021 Abril | 880 | 113 | 993 |
| 2021 Marzo | 530 | 37 | 567 |
| 2021 Febrero | 278 | 33 | 311 |
| 2021 Enero | 246 | 17 | 263 |
| 2020 Diciembre | 229 | 20 | 249 |
| 2020 Noviembre | 146 | 13 | 159 |
| 2020 Octubre | 120 | 15 | 135 |
| 2020 Septiembre | 79 | 20 | 99 |
| 2020 Agosto | 84 | 17 | 101 |
| 2020 Julio | 63 | 10 | 73 |
| 2020 Junio | 50 | 20 | 70 |
| 2020 Mayo | 61 | 21 | 82 |
| 2020 Abril | 56 | 19 | 75 |
| 2020 Marzo | 26 | 12 | 38 |
| 2020 Febrero | 2 | 2 | 4 |
Mostrar todo
