Case Study
Tympanic Paraganglioma With Extension Into the Eustachian Tube and Nasopharynx: A Case Report
Paraganglioma timpánico con extensión a trompa de Eustaquio y nasofaringe: a propósito de un caso
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A) Arteriografía de carótida interna izquierda. Se observa un compartimento de la lesión (flecha negra) irrigado por la rama caroticotimpánica de dicha arteria. B y C) Arteriografía de carótida externa izquierda. Muestra los otros 2 compartimentos: uno irrigado por la rama timpánica inferior (flecha negra) de la faríngea ascendente, y otro más caudal de mayor tamaño irrigado por ramas faríngeas de la faríngea ascendente y ramas de la arteria meníngea accesoria muy hipertrofiada (flecha blanca). D) Visión anteroposterior que muestra la extensión de la lesión.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Miriam Portero de la Torre, Rafael Sánchez Gutiérrez, Inmaculada Gallardo Muñoz, Francisco A. 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Bravo Rodríguez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Miriam" "apellidos" => "Portero de la Torre" "email" => array:1 [ 0 => "miriam_portero@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Rafael Sánchez" "apellidos" => "Gutiérrez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Inmaculada Gallardo" "apellidos" => "Muñoz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Francisco A." "apellidos" => "Bravo Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitario Reina Sofía, Córdoba, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Otorrinolaringología, Hospital Universitario Reina Sofía, Córdoba, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Paraganglioma timpánico con extensión a trompa de Eustaquio y nasofaringe: a propósito de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1581 "Ancho" => 1200 "Tamanyo" => 260572 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Digital subtraction angiography. (A) Left internal carotid arteriography. There is a compartment of the lesion (black arrow) which is irrigated by the caroticotympanic branch of the artery. (B) and (C) Left external carotid arteriography. This image shows the other 2 compartments: one irrigated by the inferior tympanic branch (black arrow) of the ascending pharyngeal, and another, larger one, irrigated by pharyngeal branches of the ascending pharyngeal artery and branches of a hypertrophied, accessory meningeal artery (white arrow). (D) Anteroposterior view showing the extension of the lesion.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Paragangliomas (also known as “glomus” or “chemodectomas”) are rare tumours derived from ectodermal cells of the neural crest. The most frequent locations in the head and neck region are the carotid body, jugular foramen, vagus nerve and middle ear (tympanic).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Tympanic paragangliomas are usually located immediately lateral to the middle ear promontory and may extend to the mastoid or the external auditory canal. Rare extensions to the Eustachian tube have also been reported.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We report the case of a recurrent tympanic paraganglioma extending to the Eustachian tube and nasopharynx.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Case</span><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was a 62-year-old female suffering recurrent epistaxis of 1-month evolution. Four years earlier she had been intervened, through left mastoidectomy, due to a left tympanomastoid paraganglioma with a millimetric component in the Eustachian tube which was controlled. During those 4 years the patient remained asymptomatic (even missing some of the scheduled reviews) until the onset of bleeding episodes.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We performed a computed tomography (CT) scan with intravenous contrast, which revealed a hypervascular mass in the left nasopharynx, extending to the Eustachian tube and middle ear and eroding the bony walls (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Diagnostic angiography showed a hypervascular lesion with 3 compartments: 1 in the middle ear, irrigated by the inferior tympanic artery (ascending pharyngeal branch), another in the petrous apex, irrigated by the caroticotympanic artery (a branch of the internal carotid artery) and another with caudal extension, irrigated by branches of the ascending pharyngeal and accessory meningeal arteries (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The findings were indicative of tympanic paraganglioma, extending into the Eustachian tube and nasopharynx.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In a second therapeutic stage, we conducted a preoperative therapeutic angiography in order to reduce the risk of bleeding during surgery. We closed the vascular supply from the middle meningeal branches, internal maxillary, stylomastoid and pharyngeal trunk of the left ascending pharyngeal artery by embolisation with Contour<span class="elsevierStyleSup">®</span> polyvinyl alcohol particles of 150–250 microns (Boston Scientific, Cork, Ireland) and fibrous coils of 2×10<span class="elsevierStyleHsp" style=""></span>mm (Boston Scientific, Cork, Ireland).</p><p id="par0045" class="elsevierStylePara elsevierViewall">Subsequently, through endoscopic sinus surgery (a less invasive technique than the external approach), we performed laser ablation of the nasopharyngeal tumour and excised the tumoural portion located in the middle ear and Eustachian tube (this resection was partial because the radical treatment entailed unassumable sequelae).</p><p id="par0050" class="elsevierStylePara elsevierViewall">The anatomopathological diagnosis was paraganglioma.</p><p id="par0055" class="elsevierStylePara elsevierViewall">After the intervention, the patient underwent radiosurgery of the nasopharyngeal component. In the last control CT scan (2 years after surgery), this component had become reduced to half its original size and the patient remained asymptomatic.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Paragangliomas are rare tumours. The peak age of onset is between the fifth and sixth decades of life, with a higher prevalence among women.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Paragangliomas have capsules with septa and a stroma composed of sinusoidal spaces which are anastomosed together, thus giving them their characteristic hypervascularity with pathognomonic arteriographic signs and haemorrhagic character (which justifies preoperative embolisation).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Tympanic paragangliomas originate from glomus bodies of the cochlear promontory, along the tympanic branch of the glossopharyngeal nerve (nerve of Jacobson). Examination usually reveals a hypotympanic or mesotympanic mass, with the most common symptoms being pulsatile tinnitus and unilateral hearing loss. CT and magnetic resonance imaging (MRI) scans show a mass in the medial wall of the middle ear, which may extend to the mastoid or external ear canal. Angiography shows characteristic findings, revealing a hypervascular mass with compartmentalised vascularisation by specific hypertrophied arteries.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The differential diagnosis should include undifferentiated carcinoma, which shows less enhancement after contrast administration, haemangioma and Kaposi sarcoma, which are vascular tumours, although there are no reported cases of Eustachian tube extension, and juvenile nasopharyngeal angiofibroma, which is a highly vascular tumour, almost exclusively found in adolescent males.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Only 4 cases of tympanic paraganglioma extending into the Eustachian tube and nasopharynx have been published,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–5</span></a> all of them occurring in women aged between 50 and 65 years and beginning with epistaxis, as in our patient. In the cases described, the diagnosis was obtained by CT<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–5</span></a> and/or MRI,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> supplemented in some cases by angiography<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a> and biopsy.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Treatment was surgical resection<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> or radiotherapy<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> (1 patient underwent ligation of the external carotid artery prior to radiotherapy<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>). Only 1 of these cases underwent preoperative embolisation by angiography.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Our case illustrates a very unusual extension of tympanic paraganglioma, with characteristic findings on CT scans and angiography. The latter was useful in both diagnosis and preoperative treatment of the lesion.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In summary, the diagnosis of paraganglioma should be considered in patients with epistaxis and CT and/or MRI findings of hypervascular lesions in the middle ear extending to the Eustachian tube and nasopharynx. In such cases, angiography will enable better characterisation of the lesion and its vascular supply. Embolisation prior to biopsy or surgical resection will diminish the risk of uncontrollable bleeding.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interests</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres95019" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec82170" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres95018" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec82171" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical Case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of Interests" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec82170" "palabras" => array:4 [ 0 => "Tympanic paraganglioma" 1 => "Eustachian tube" 2 => "Nasopharynx" 3 => "Epistaxis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec82171" "palabras" => array:4 [ 0 => "Paraganglioma timpánico" 1 => "Trompa de Eustaquio" 2 => "Nasofaringe" 3 => "Epistaxis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tympanic paragangliomas usually present as a vascular middle ear mass, with the most common presenting symptoms being pulsatile tinnitus and hearing loss. We report an unusual case of a recurrent tympanic paraganglioma extending along the Eustachian tube and nasopharynx, presenting with recurrent epistaxis.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los paragangliomas timpánicos suelen presentarse como una masa hipervascular en oído medio, siendo los síntomas de presentación más frecuentes acúfeno pulsátil e hipoacusia. Presentamos un caso infrecuente de recidiva de paraganglioma timpánico con extensión a trompa de Eustaquio y nasofaringe, que debutó con epistaxis recurrente.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Portero de la Torre M, et al. Paraganglioma timpánico con extensión a trompa de Eustaquio y nasofaringe: a propósito de un caso. Acta Otorrinolaringol Esp. 2012;63:314–7.</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" => 827 "Ancho" => 2000 "Tamanyo" => 195092 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">CT scan with intravenous contrast. The axial (A) and coronal (B) sections show a hypervascular mass located in the left nasopharynx (white arrow), Eustachian tube (black arrow) and middle ear. (C) Reconstruction of the lesion in the major axis (white arrow), showing its extension from the middle ear to the nasopharynx.</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" => 1581 "Ancho" => 1200 "Tamanyo" => 260572 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Digital subtraction angiography. (A) Left internal carotid arteriography. There is a compartment of the lesion (black arrow) which is irrigated by the caroticotympanic branch of the artery. (B) and (C) Left external carotid arteriography. This image shows the other 2 compartments: one irrigated by the inferior tympanic branch (black arrow) of the ascending pharyngeal, and another, larger one, irrigated by pharyngeal branches of the ascending pharyngeal artery and branches of a hypertrophied, accessory meningeal artery (white arrow). (D) Anteroposterior view showing the extension of the lesion.</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" => "From de archives of the AFIP. Paragangliomas of the head and neck: radiologic–pathologic correlation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.B. Rao" 1 => "K.K. Koeller" 2 => "C.F. Adair" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiographics.19.6.g99no251605" "Revista" => array:6 [ "tituloSerie" => "Radiographics" "fecha" => "1999" "volumen" => "19" "paginaInicial" => "1605" "paginaFinal" => "1632" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10555678" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nasopharyngeal extension of glomus tympanicum: an unusual clinical and imaging manifestation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Hirunpat" 1 => "K. Riabroi" 2 => "C. Dechsukhum" 3 => "V. Atchariyasathian" 4 => "W. Tanomkiat" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Neuroradiol" "fecha" => "2006" "volumen" => "27" "paginaInicial" => "1820" "paginaFinal" => "1822" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17032849" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unusual eustachian tube mass: glomus tympanicum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Lum" 1 => "A.M. Keller" 2 => "E. Kassel" 3 => "R. Blend" 4 => "J. Waldron" 5 => "J. Rutka" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "2001" "volumen" => "22" "paginaInicial" => "508" "paginaFinal" => "509" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11237975" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Jugulotympanic paraganglioma (glomus tumour) presenting with recurrent epistaxis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K.G. Effat" 1 => "M. Karam" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1258/002221504772784658" "Revista" => array:6 [ "tituloSerie" => "J Laryngol Otol" "fecha" => "2004" "volumen" => "118" "paginaInicial" => "153" "paginaFinal" => "155" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14979957" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Resection of a recurrent paraganglioma via an endoscopic transnasal approach to the jugular fossa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L.A. Zimmer" 1 => "B.E. Hirsch" 2 => "A. Kassam" 3 => "M. Horowitz" 4 => "C.H. Snyderman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Otol Neurotol" "fecha" => "2006" "volumen" => "27" "paginaInicial" => "398" "paginaFinal" => "402" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16639280" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnóstico y control evolutivo de los paragangliomas de cabeza y cuello. Interés de la angiografía y procedimientos neurorradiológicos intervencionistas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Pérez Higueras" 1 => "P. Saura Lorente" 2 => "J. García Alonso" 3 => "J.A. de las Heras García" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Acta Otorrinolaringol Esp" "fecha" => "2009" "volumen" => "60" "numero" => "Suppl. 1" "paginaInicial" => "53" "paginaFinal" => "67" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19245776" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735735/0000006300000004/v1_201304231517/S2173573512000750/v1_201304231517/en/main.assets" "Apartado" => array:4 [ "identificador" => "5881" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Studies" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735735/0000006300000004/v1_201304231517/S2173573512000750/v1_201304231517/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573512000750?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
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| 2023 March | 1 | 0 | 1 |
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| 2020 May | 0 | 3 | 3 |
| 2020 March | 29 | 8 | 37 |
| 2020 February | 28 | 4 | 32 |
| 2020 January | 18 | 13 | 31 |
| 2019 December | 47 | 12 | 59 |
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| 2019 September | 34 | 5 | 39 |
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| 2018 October | 23 | 4 | 27 |
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| 2018 April | 26 | 2 | 28 |
| 2018 March | 17 | 9 | 26 |
| 2018 February | 52 | 2 | 54 |
| 2018 January | 28 | 3 | 31 |
| 2017 December | 63 | 3 | 66 |
| 2017 November | 13 | 7 | 20 |
| 2017 October | 25 | 3 | 28 |
| 2017 September | 30 | 8 | 38 |
| 2017 August | 16 | 2 | 18 |
| 2017 July | 21 | 3 | 24 |
| 2017 June | 22 | 7 | 29 |
| 2017 May | 28 | 3 | 31 |
| 2017 April | 25 | 6 | 31 |
| 2017 March | 31 | 33 | 64 |
| 2017 February | 34 | 5 | 39 |
| 2017 January | 19 | 2 | 21 |
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| 2016 November | 39 | 6 | 45 |
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