Case for Diagnosis
Progressive Asymptomatic Thickening of a Lip
Engrosamiento labial progresivo asintomático
R. Ruiz-Villaverde
, B. Rueda-Villafranca, M. Galvez-Moreno
Autor para correspondencia
Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain
Leído
3938
Vecesse ha leído el artículo
1504
Total PDF
2434
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1578219021001621" "issn" => "15782190" "doi" => "10.1016/j.adengl.2021.05.003" "estado" => "S300" "fechaPublicacion" => "2021-07-01" "aid" => "2607" "copyright" => "AEDV" "copyrightAnyo" => "2021" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2021;112:645-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:20 [ "pii" => "S1578219021001554" "issn" => "15782190" "doi" => "10.1016/j.adengl.2021.04.001" "estado" => "S300" "fechaPublicacion" => "2021-07-01" "aid" => "2545" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2021;112:647-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Practical Dermoscopy</span>" "titulo" => "Violaceous Papule on the Trunk" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "647" "paginaFinal" => "648" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pápula violácea en tronco" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 455 "Ancho" => 805 "Tamanyo" => 56941 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dermoscopic image of the lesion (DermLite 4). The reddish-violaceous homogeneous lesion is surrounded by a biphasic halo. The first halo has a yellowish-orange tinge (*) and the second halo on the periphery is reddish. The hair follicles remain intact.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F.J. Navarro-Triviño" "autores" => array:1 [ 0 => array:2 [ "nombre" => "F.J." "apellidos" => "Navarro-Triviño" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S000173102030510X" "doi" => "10.1016/j.ad.2019.09.010" "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/S000173102030510X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021001554?idApp=UINPBA000044" "url" => "/15782190/0000011200000007/v1_202107020822/S1578219021001554/v1_202107020822/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1578219021001700" "issn" => "15782190" "doi" => "10.1016/j.adengl.2021.05.010" "estado" => "S300" "fechaPublicacion" => "2021-07-01" "aid" => "2612" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2021;112:640-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Are Oral Mucosal Changes a Sign of COVID-19? A Cross-Sectional Study at a Field Hospital" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "640" "paginaFinal" => "644" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Son las alteraciones en la mucosa oral un signo de COVID-19? Estudio transversal en un Hospital de Campaña" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 926 "Ancho" => 1804 "Tamanyo" => 270054 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Characteristic tongue swelling or macroglossia (6.6%) associated with transient U-shaped lingual papillitis (11.5%) in patients with COVID-19. A, Illustration showing tongue changes with indentation on both sides of the tongue and inflammation of anterior papillae, probably caused by friction. B–E, Tongue swelling and transient U-shaped lingual papillitis during COVID-19. COVID-19 indicates coronavirus disease 2019.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Nuño González, K. Magaletskyy, P. Martín Carrillo, B. Lozano Masdemont, A. Mayor Ibarguren, M. Feito Rodríguez, P. Herranz Pinto" "autores" => array:7 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Nuño González" ] 1 => array:2 [ "nombre" => "K." "apellidos" => "Magaletskyy" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Martín Carrillo" ] 3 => array:2 [ "nombre" => "B." "apellidos" => "Lozano Masdemont" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Mayor Ibarguren" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Feito Rodríguez" ] 6 => array:2 [ "nombre" => "P." "apellidos" => "Herranz Pinto" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021001700?idApp=UINPBA000044" "url" => "/15782190/0000011200000007/v1_202107020822/S1578219021001700/v1_202107020822/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>" "titulo" => "Progressive Asymptomatic Thickening of a Lip" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "645" "paginaFinal" => "646" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. Ruiz-Villaverde, B. Rueda-Villafranca, M. Galvez-Moreno" "autores" => array:3 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Ruiz-Villaverde" "email" => array:1 [ 0 => "ismenios@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Rueda-Villafranca" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Galvez-Moreno" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Engrosamiento labial progresivo asintomático" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1253 "Ancho" => 2174 "Tamanyo" => 333805 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemistry, original magnification ×10. Left, negative staining for immunoglobulin (Ig) G κ light chain. Right, positive staining for IgG λ light chain.</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">A 65-year-old woman with no drug allergies and a medical history of type II diabetes mellitus, dyslipidemia, and HLA-B27-positive seronegative spondyloarthropathy, was referred from the hematology department for progressive asymptomatic thickening of the lip that had begun several months earlier. The patient was undergoing tests for moderate iron deficiency anemia and a monoclonal immunoglobulin (Ig) G λ band. Prior tests had revealed no other findings of interest.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">The patient’s upper lip was thickened and hard to the touch, without associated ulcers (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Neither locoregional lymphadenopathy nor hepatosplenomegaly were palpable. Examination of the skin and mucosa revealed no other lesions.</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 showed lymphoid clusters consisting mainly of plasma cells with a periglandular distribution (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Immunohistochemistry was positive for CD20 and negative for IgG and IgG4, and revealed monoclonal λ light chains but was negative for κ light chains (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</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">Additional tests revealed a normal complete blood count and a normal biochemical profile. Quantification of IgG λ light chain in serum continued to show elevated levels (3.20 g/dL). The results of the autoimmunity study were normal. The results of a bone marrow aspiration (BMA) biopsy were within the normal range. The first positron emission tomography–computed tomography (PET–CT) scan showed foci of mild-to-moderate metabolic activity associated with paratracheal lymphadenopathy suggestive of benign inflammatory disease.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">What Is Your Diagnosis?</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Diagnosis</span><p id="par0025" class="elsevierStylePara elsevierViewall">Lymphocytic hyperplasia with monoclonal IgG λ plasmacytosis.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Clinical Course and Treatment</span><p id="par0030" class="elsevierStylePara elsevierViewall">BMA biopsy was repeated 3 months later and revealed an increase in plasma cells (2.5%) and clonal B lymphocytes with weak cytoplasmic expression of IgG λ light chain. A second PET–CT scan was performed 6 months later and compared with previous images. The scan showed findings compatible with adenopathies suggestive of lymphomatous spread and a probable diagnosis of IgG λ lymphoplasmacytic lymphoma. Treatment with cycles of rituximab, cyclophosphamide, and dexamethasone (RCD) resulted in a progressive decrease in the monoclonal component, but had no effect on the patient’s lip condition.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Comment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Monoclonal plasmacytosis in minor salivary gland biopsies is observed in autoimmune diseases such as Sjögren syndrome, in the early stages of mucosa-associated lymphoid tissue lymphoma, and even in monoclonal gammopathy of uncertain significance.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Lip and minor salivary gland involvement, as observed in the present case, may be the first manifestation of lymphoma with systemic compromise. Transition between lymphocytic infiltrate with apparently benign characteristics and lymphoma occurs relatively frequently, in some cases separated by intermediate stages that are difficult to classify. Therefore, clonal proliferations in clinically accessible locations (e.g. the lip, which in our patient became progressively thickened) should be evaluated with caution. It is necessary to clinically rule out processes such as granulomatous cheilitis in Melkersson-Roshental syndrome<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and Sjögren syndrome, in which these clonal proliferations have also been described, as well as IgG4-related disease,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> which was ruled out in our patient.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Histologically, features that suggest benignity include preserved acinar architecture and the presence of small lymphocytes and plasma cells in the interfollicular regions with a nondiffuse pattern distinct from that of lymphoproliferative infiltrate.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Ultimately, our patient was diagnosed with IgG λ lymphoplasmacytic lymphoma. In 2008<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> the World Health Organization defined this condition as a B-cell neoplasm consisting of coexisting clonal populations of small B cells, lymphoplasmacytes, and plasma cells. It is frequently associated with a monoclonal IgM component (Waldenstrom macroglobulinemia) and less than 5% of patients present a monoclonal IgG band,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> which was observed in our patient.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Funding</span><p id="par0050" class="elsevierStylePara elsevierViewall">No funding was received for this study.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</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:3 [ "identificador" => "sec0025" "titulo" => "What Is Your Diagnosis?" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Diagnosis" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Clinical Course and Treatment" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Comment" ] ] ] 5 => array:2 [ "identificador" => "sec0045" "titulo" => "Funding" ] 6 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflicts of interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-04-02" "fechaAceptado" => "2019-07-14" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ruiz-Villaverde R, Rueda-Villafranca B, Galvez-Moreno M. Engrosamiento labial progresivo asintomático. Actas Dermosifiliogr. 2021;112:645–646.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1674 "Ancho" => 1257 "Tamanyo" => 148696 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Symmetrical thickening of the lower lip.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1249 "Ancho" => 2174 "Tamanyo" => 364491 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×10.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1253 "Ancho" => 2174 "Tamanyo" => 333805 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemistry, original magnification ×10. Left, negative staining for immunoglobulin (Ig) G κ light chain. Right, positive staining for IgG λ light chain.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clonally expanded lymphocytes in the minor salivary glands of Sjögren’s syndrome patients without lymphoproliferative disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.L. Pablos" 1 => "P.E. Carreira" 2 => "L. Morillas" 3 => "G. Montalvo" 4 => "C. Ballestin" 5 => "J.J. Gomez-Reino" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.1780371006" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum." "fecha" => "1994" "volumen" => "37" "paginaInicial" => "1441" "paginaFinal" => "1444" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7945468" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Melkersson-Rosenthal syndrome: a case report of a rare disease with overlapping features" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Cancian" 1 => "S. Giovannini" 2 => "A. Angelini" 3 => "M. Fedrigo" 4 => "R. Bendo" 5 => "R. Senter" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Allergy Asthma Clin Immunol." "fecha" => "2019" "volumen" => "15" "paginaInicial" => "1" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lesional CD4+IFN-γ+ cytotoxic T lymphocytes in IgG4-related dacryoadenitis and sialoadenitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Maehara" 1 => "H. Mattoo" 2 => "M. Ohta" 3 => "V.S. Mahajan" 4 => "M. Moriyama" 5 => "M. Yamauchi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/annrheumdis-2016-209139" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis." "fecha" => "2017" "volumen" => "76" "paginaInicial" => "377" "paginaFinal" => "385" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27358392" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathological features of lymphoid proliferations of the salivary glands: lymphoepithelial sialadenitis versus low-grade B-cell lymphoma of the malt type" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Carbone" 1 => "A. Gloghini" 2 => "A. Ferlito" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/000348940010901217" "Revista" => array:7 [ "tituloSerie" => "Ann Otol Rhinol Laryngol." "fecha" => "2000" "volumen" => "109" "numero" => "12 Pt 1" "paginaInicial" => "1170" "paginaFinal" => "1175" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11130833" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The 2008 WHO classification of lymphoid neoplasms and beyond: evolving concepts and practical applications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E. Campo" 1 => "S.H. Swerdlow" 2 => "N.L. Harris" 3 => "S. Pileri" 4 => "H. Stein" 5 => "E.S. Jaffe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/blood-2011-01-293050" "Revista" => array:6 [ "tituloSerie" => "Blood." "fecha" => "2011" "volumen" => "117" "paginaInicial" => "5019" "paginaFinal" => "5032" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21300984" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lymphoplasmacytic lymphoma and other non-marginal zone lymphomas with plasmacytic differentiation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Lin" 1 => "T.J. Molina" 2 => "J.R. Cook" 3 => "S.H. Swerdlow" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1309/AJCP8FOIVTB6LBER" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Pathol." "fecha" => "2011" "volumen" => "136" "paginaInicial" => "195" "paginaFinal" => "210" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21757593" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011200000007/v1_202107020822/S1578219021001621/v1_202107020822/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/15782190/0000011200000007/v1_202107020822/S1578219021001621/v1_202107020822/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021001621?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 22 | 12 | 34 |
| 2024 Octubre | 75 | 42 | 117 |
| 2024 Septiembre | 84 | 18 | 102 |
| 2024 Agosto | 113 | 49 | 162 |
| 2024 Julio | 79 | 21 | 100 |
| 2024 Junio | 98 | 30 | 128 |
| 2024 Mayo | 87 | 34 | 121 |
| 2024 Abril | 70 | 31 | 101 |
| 2024 Marzo | 69 | 25 | 94 |
| 2024 Febrero | 85 | 37 | 122 |
| 2024 Enero | 71 | 39 | 110 |
| 2023 Diciembre | 60 | 18 | 78 |
| 2023 Noviembre | 92 | 37 | 129 |
| 2023 Octubre | 56 | 26 | 82 |
| 2023 Septiembre | 62 | 35 | 97 |
| 2023 Agosto | 66 | 19 | 85 |
| 2023 Julio | 61 | 40 | 101 |
| 2023 Junio | 53 | 20 | 73 |
| 2023 Mayo | 59 | 29 | 88 |
| 2023 Abril | 52 | 37 | 89 |
| 2023 Marzo | 71 | 29 | 100 |
| 2023 Febrero | 27 | 20 | 47 |
| 2023 Enero | 41 | 41 | 82 |
| 2022 Diciembre | 45 | 57 | 102 |
| 2022 Noviembre | 20 | 27 | 47 |
| 2022 Octubre | 32 | 15 | 47 |
| 2022 Septiembre | 43 | 43 | 86 |
| 2022 Agosto | 32 | 32 | 64 |
| 2022 Julio | 28 | 35 | 63 |
| 2022 Junio | 21 | 26 | 47 |
| 2022 Mayo | 45 | 46 | 91 |
| 2022 Abril | 49 | 28 | 77 |
| 2022 Marzo | 60 | 71 | 131 |
| 2022 Febrero | 47 | 42 | 89 |
| 2022 Enero | 39 | 36 | 75 |
| 2021 Diciembre | 40 | 41 | 81 |
| 2021 Noviembre | 57 | 44 | 101 |
| 2021 Octubre | 54 | 71 | 125 |
| 2021 Septiembre | 39 | 51 | 90 |
| 2021 Agosto | 60 | 53 | 113 |
| 2021 Julio | 83 | 37 | 120 |
| 2021 Junio | 46 | 28 | 74 |
| 2021 Mayo | 41 | 32 | 73 |
Mostrar todo
