Case report
B-cell lymphoma of the heart: A rare diagnosis
Linfoma de células B do coração – Um diagnóstico raro
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A geometria demonstrada pertence ao átrio direito, ventrículo direito e seio coronariano. 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Matos, João Palas, Constantinos Doulaptsis, Miguel Ramalho, Sérgio Duarte, Jan Bogaert" "autores" => array:6 [ 0 => array:4 [ "nombre" => "António P." "apellidos" => "Matos" "email" => array:1 [ 0 => "antoniopmatos@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "João" "apellidos" => "Palas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Constantinos" "apellidos" => "Doulaptsis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Miguel" "apellidos" => "Ramalho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Sérgio" "apellidos" => "Duarte" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "Jan" "apellidos" => "Bogaert" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Radiology, Hospital Garcia de Orta, Almada, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Radiology, UZ Leuven, Luven, Belgium" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Radiology, Hospital da Luz, Lisboa, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Linfoma de células B do coração – Um diagnóstico raro" ] ] "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" => 533 "Ancho" => 1501 "Tamanyo" => 111745 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Axial (a) and coronal reconstructed (b) images from non-ECG-gated enhanced computed tomography, at presentation. A primary cardiac lymphoma (asterisks, a, b) extends through the atrioventricular groove, the right atrial chamber and interatrial septum (asterisks). The patency of the right coronary artery (arrow, a) is preserved. A mild pericardial effusion is present (arrowhead, a) and superficial collateral circulation is shown (curved arrows, a). Coronal reconstructed images better illustrate the sparing of the aortic root (arrow, b) and obstruction of the superior vena cava (arrowhead, b).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Case presentation</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 60-year-old woman with a history of inferior myocardial infarction presented to the emergency department due to chest pain and recurrent episodes of syncope. Physical examination was unremarkable except for mild ectasia of the superficial thoracic wall vessels and regular bradycardia. The ECG showed de novo atrial fibrillation (AF) and a junctional rhythm of 40 bpm. Laboratory tests were unremarkable, except for elevated lactate dehydrogenase (LDH) of 768 UI/l (normal 240–480 UI/l). Transthoracic echocardiography (TTE) showed no significant abnormality.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Pacemaker implantation for symptomatic bradycardia was proposed. During the fluoroscopy-guided transsubclavian vein positioning of the pacing leads, complete obstruction of the superior vena cava (SVC) was noticed, and the procedure was aborted. To elucidate the obstruction, a chest multidetector computed tomography (CT) scan was performed (BrightSpeed® 16 slice, GE Healthcare, Milwaukee, Wisconsin, USA) before and after intravenous contrast administration (120 ml of iopromide [Ultravist 370] at a rate of 3.5 ml/s) (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). Contrast-enhanced CT (non-ECG-gated) showed an infiltrative, hypoattenuating mass, apparently arising from the right atrium (RA) free wall and extending along the interatrial septum and epicardium, through the atrioventricular (AV) groove, following the course of the right coronary artery (RCA). No endoluminal arterial invasion was noted but the mass extended to the RA chamber, occluding the SVC. The mass showed no calcifications or necrosis, revealing mild enhancement. The proximal RCA was patent and a small pericardial effusion was observed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A pronounced collateral circulation was evident along the thoracic wall, due to SVC obstruction. Based on the imaging findings the hypothesis of primary cardiac lymphoma (PCL) was proposed.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Histopathology following endomyocardial biopsies revealed a diffuse large B-cell non-Hodgkin lymphoma (CD20+ and BCL6+). Whole-body CT and bone marrow biopsy revealed no extracardiac spread.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A pacemaker for symptomatic bradycardia was finally implanted via the femoral vein.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Chemotherapy with R-COP (rituximab associated with cyclophosphamide, vincristine and prednisolone) was begun.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Follow-up CT performed three months later showed moderate decrease in tumor volume (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Malignant tumors of the heart are rare and mostly metastatic. Secondary involvement of the heart in the context of a systemic lymphoma is frequently found at autopsy. PCL, i.e. the exclusive involvement of the heart and/or the pericardium by a lymphoma, accounts for only 1.3% of cardiac tumors and 0.5% of extranodal lymphomas.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">PCLs are predominantly large B-cell non-Hodgkin lymphomas and can arise from the epicardium or the myocardium, more frequently in the right cardiac chambers and mostly the RA.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The clinical presentation is heterogeneous.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Several non-specific electrocardiographic abnormalities can be found associated with PCL.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Complete AV block is the most frequently observed ECG abnormality, as seen in our patient.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The laboratory data are usually non-specific. Elevated LDH is the most notable finding. TTE is frequently the first-line imaging method; TEE often provides satisfactory images of the right atrium,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> but previous studies have shown a relatively low sensitivity and specificity.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> CT and magnetic resonance imaging (MRI) have an excellent spatial resolution, and can easily depict cardiac tumors and provide visualization of the great vessels, heart, pericardium, mediastinum and lung.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> CT usually depicts PCL as an infiltrating epicardial or myocardial mass that is often isoattenuating to hypoattenuating relative to the myocardium. After intravenous contrast, heterogeneous slow enhancement is often shown. The tumor extends along the epicardial surfaces of the heart and AV groove, encasing structures including the coronary arteries and aortic root. These features were present in our case. Pericardial effusion and thickening are common findings.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> MRI may be the best modality to depict the cardiac extension of the disease.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">CT and MRI suggest the differential diagnosis between PCL and angiosarcoma (the most common primary malignancy of the heart) also arising from the RA. Angiosarcomas are extremely invasive through the vessels (coronaries or great vessels) and the valve annular plane. Strong enhancement after contrast is expected in angiosarcomas but not in lymphoma. Central necrosis is also commonly found in angiosarcoma, but is rare in lymphoma.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Other possible differential diagnosis should include metastatic origin,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> but our patient had no history of extra-cardiac malignancies.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Patients with PCL have a poor prognosis due to late diagnosis and the aggressiveness of the disease.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Prompt diagnosis may allow early treatment and improved prognosis. Contrast-enhanced multidetector CT, along with a high clinical suspicion to detect RA tumors, can improve the early diagnosis of PCL.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Ethical disclosures</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Protection of human and animal subjects</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Confidentiality of data</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Right to privacy and informed consent</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of interest</span><p id="par0075" 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" => "xres390365" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec368535" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres390366" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec368536" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Case presentation" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Discussion" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Right to privacy and informed consent" ] ] ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-02-06" "fechaAceptado" => "2014-07-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec368535" "palabras" => array:5 [ 0 => "Heart" 1 => "Lymphoma" 2 => "Neoplasm" 3 => "Cardiac tumor" 4 => "Computed tomography" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec368536" "palabras" => array:5 [ 0 => "Coração" 1 => "Linfoma" 2 => "Neoplasia" 3 => "Tumor cardíaco" 4 => "Tomografia computorizada" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We present a case of a primary cardiac lymphoma in a 60-year-old woman. The clinical presentation was non-specific and the diagnosis was suggested by its appearance on multidetector computed tomography. The final diagnosis was achieved by histopathological study and was corroborated by a decrease in tumor volume after targeted chemotherapy. A brief review of the appearance of primary cardiac lymphomas in imaging studies is presented.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Os autores apresentam um caso de linfoma cardíaco primário diagnosticado numa mulher de 60 anos. Enquanto que a apresentação clínica foi inespecífica, o diagnóstico foi proposto por tomografia computorizada. O diagnóstico definitivo foi efetuado por histopatologia. A redução do volume tumoral após quimioterapia dirigida corroborou o diagnóstico. A propósito do caso clínico foi efetuada uma breve revisão da expressão radiológica dos linfomas cardíacos primários.</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" => 533 "Ancho" => 1501 "Tamanyo" => 111745 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Axial (a) and coronal reconstructed (b) images from non-ECG-gated enhanced computed tomography, at presentation. A primary cardiac lymphoma (asterisks, a, b) extends through the atrioventricular groove, the right atrial chamber and interatrial septum (asterisks). The patency of the right coronary artery (arrow, a) is preserved. A mild pericardial effusion is present (arrowhead, a) and superficial collateral circulation is shown (curved arrows, a). Coronal reconstructed images better illustrate the sparing of the aortic root (arrow, b) and obstruction of the superior vena cava (arrowhead, b).</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" => 550 "Ancho" => 1500 "Tamanyo" => 119347 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Axial image (a) and coronal reconstructed (b) images from non-ECG-gated enhanced computed tomography, after three months of chemotherapy. The decrease in size of the primary cardiac lymphoma mass can be seen (asterisks, a, b). Note the pacing leads in the right chambers (arrows, a, b).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary cardiac lymphoma in immunocompetent patients: diagnostic and therapeutic management" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G.L. Ceresoli" 1 => "A.J. Ferreri" 2 => "E. Bucci" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "1997" "volumen" => "80" "paginaInicial" => "1497" "paginaFinal" => "1506" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9338475" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary cardiac lymphoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.E. Miguel" 1 => "R.B. Bestetti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijcard.2010.02.016" "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "2011" "volumen" => "149" "paginaInicial" => "358" "paginaFinal" => "363" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20227122" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "From the radiologic pathology archives: cardiac lymphoma: radiologic-pathologic correlation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Jeudy" 1 => "J. Kirsch" 2 => "F. Tavora" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/rg.325115126" "Revista" => array:6 [ "tituloSerie" => "Radiographics" "fecha" => "2012" "volumen" => "32" "paginaInicial" => "1369" "paginaFinal" => "1380" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22977025" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of reversible ventricular tachycardia and complete atrioventricular block associated with primary cardiac B-cell lymphoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Y. Tanaka" 1 => "H. Yamabe" 2 => "H. Yamasaki" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1540-8159.2009.02372.x" "Revista" => array:6 [ "tituloSerie" => "Pace" "fecha" => "2009" "volumen" => "32" "paginaInicial" => "816" "paginaFinal" => "819" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19545348" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of primary cardiac lymphoma mimicking acute coronary and aortic syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.W. Cho" 1 => "K.B. Kim" 2 => "J.T. Hwang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4070/kcj.2012.42.11.776" "Revista" => array:6 [ "tituloSerie" => "Korean Circ J" "fecha" => "2012" "volumen" => "42" "paginaInicial" => "776" "paginaFinal" => "780" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23236331" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003300000012/v1_201412140112/S0870255114002856/v1_201412140112/en/main.assets" "Apartado" => array:4 [ "identificador" => "362" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Casos clínicos" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003300000012/v1_201412140112/S0870255114002856/v1_201412140112/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255114002856?idApp=UINPBA00004E" ]
| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 10 | 7 | 17 |
| 2024 Outubro | 51 | 28 | 79 |
| 2024 Setembro | 52 | 32 | 84 |
| 2024 Agosto | 61 | 30 | 91 |
| 2024 Julho | 40 | 38 | 78 |
| 2024 Junho | 54 | 24 | 78 |
| 2024 Maio | 59 | 27 | 86 |
| 2024 Abril | 42 | 33 | 75 |
| 2024 Maro | 49 | 26 | 75 |
| 2024 Fevereiro | 34 | 36 | 70 |
| 2024 Janeiro | 22 | 36 | 58 |
| 2023 Dezembro | 34 | 29 | 63 |
| 2023 Novembro | 47 | 24 | 71 |
| 2023 Outubro | 36 | 21 | 57 |
| 2023 Setembro | 36 | 23 | 59 |
| 2023 Agosto | 39 | 23 | 62 |
| 2023 Julho | 55 | 11 | 66 |
| 2023 Junho | 35 | 20 | 55 |
| 2023 Maio | 50 | 23 | 73 |
| 2023 Abril | 29 | 5 | 34 |
| 2023 Maro | 51 | 24 | 75 |
| 2023 Fevereiro | 40 | 17 | 57 |
| 2023 Janeiro | 36 | 14 | 50 |
| 2022 Dezembro | 30 | 23 | 53 |
| 2022 Novembro | 61 | 26 | 87 |
| 2022 Outubro | 34 | 19 | 53 |
| 2022 Setembro | 39 | 36 | 75 |
| 2022 Agosto | 70 | 24 | 94 |
| 2022 Julho | 49 | 38 | 87 |
| 2022 Junho | 26 | 21 | 47 |
| 2022 Maio | 38 | 26 | 64 |
| 2022 Abril | 43 | 20 | 63 |
| 2022 Maro | 40 | 37 | 77 |
| 2022 Fevereiro | 32 | 18 | 50 |
| 2022 Janeiro | 56 | 21 | 77 |
| 2021 Dezembro | 34 | 27 | 61 |
| 2021 Novembro | 41 | 29 | 70 |
| 2021 Outubro | 44 | 33 | 77 |
| 2021 Setembro | 42 | 29 | 71 |
| 2021 Agosto | 44 | 29 | 73 |
| 2021 Julho | 47 | 27 | 74 |
| 2021 Junho | 44 | 15 | 59 |
| 2021 Maio | 53 | 28 | 81 |
| 2021 Abril | 68 | 24 | 92 |
| 2021 Maro | 54 | 17 | 71 |
| 2021 Fevereiro | 94 | 17 | 111 |
| 2021 Janeiro | 61 | 8 | 69 |
| 2020 Dezembro | 61 | 8 | 69 |
| 2020 Novembro | 46 | 14 | 60 |
| 2020 Outubro | 44 | 11 | 55 |
| 2020 Setembro | 69 | 8 | 77 |
| 2020 Agosto | 36 | 5 | 41 |
| 2020 Julho | 34 | 8 | 42 |
| 2020 Junho | 48 | 7 | 55 |
| 2020 Maio | 34 | 4 | 38 |
| 2020 Abril | 45 | 21 | 66 |
| 2020 Maro | 50 | 6 | 56 |
| 2020 Fevereiro | 164 | 38 | 202 |
| 2020 Janeiro | 57 | 8 | 65 |
| 2019 Dezembro | 63 | 10 | 73 |
| 2019 Novembro | 40 | 7 | 47 |
| 2019 Outubro | 66 | 5 | 71 |
| 2019 Setembro | 70 | 8 | 78 |
| 2019 Agosto | 42 | 5 | 47 |
| 2019 Julho | 38 | 9 | 47 |
| 2019 Junho | 51 | 17 | 68 |
| 2019 Maio | 63 | 8 | 71 |
| 2019 Abril | 38 | 11 | 49 |
| 2019 Maro | 42 | 10 | 52 |
| 2019 Fevereiro | 39 | 13 | 52 |
| 2019 Janeiro | 44 | 5 | 49 |
| 2018 Dezembro | 87 | 11 | 98 |
| 2018 Novembro | 71 | 6 | 77 |
| 2018 Outubro | 155 | 19 | 174 |
| 2018 Setembro | 61 | 10 | 71 |
| 2018 Agosto | 77 | 12 | 89 |
| 2018 Julho | 36 | 4 | 40 |
| 2018 Junho | 60 | 6 | 66 |
| 2018 Maio | 82 | 10 | 92 |
| 2018 Abril | 70 | 5 | 75 |
| 2018 Maro | 137 | 13 | 150 |
| 2018 Fevereiro | 58 | 2 | 60 |
| 2018 Janeiro | 58 | 7 | 65 |
| 2017 Dezembro | 90 | 9 | 99 |
| 2017 Novembro | 41 | 7 | 48 |
| 2017 Outubro | 36 | 13 | 49 |
| 2017 Setembro | 47 | 4 | 51 |
| 2017 Agosto | 48 | 11 | 59 |
| 2017 Julho | 39 | 9 | 48 |
| 2017 Junho | 44 | 10 | 54 |
| 2017 Maio | 56 | 8 | 64 |
| 2017 Abril | 19 | 3 | 22 |
| 2017 Maro | 23 | 3 | 26 |
| 2017 Fevereiro | 33 | 5 | 38 |
| 2017 Janeiro | 31 | 4 | 35 |
| 2016 Dezembro | 34 | 15 | 49 |
| 2016 Novembro | 27 | 13 | 40 |
| 2016 Outubro | 28 | 7 | 35 |
| 2016 Setembro | 21 | 7 | 28 |
| 2016 Agosto | 10 | 4 | 14 |
| 2016 Julho | 10 | 8 | 18 |
| 2016 Junho | 1 | 0 | 1 |
| 2016 Maio | 7 | 9 | 16 |
| 2016 Abril | 19 | 1 | 20 |
| 2016 Maro | 56 | 16 | 72 |
| 2016 Fevereiro | 73 | 27 | 100 |
| 2016 Janeiro | 42 | 24 | 66 |
| 2015 Dezembro | 51 | 13 | 64 |
| 2015 Novembro | 65 | 20 | 85 |
| 2015 Outubro | 43 | 21 | 64 |
| 2015 Setembro | 38 | 20 | 58 |
| 2015 Agosto | 50 | 18 | 68 |
| 2015 Julho | 43 | 11 | 54 |
| 2015 Junho | 36 | 6 | 42 |
| 2015 Maio | 67 | 16 | 83 |
| 2015 Abril | 38 | 31 | 69 |
| 2015 Maro | 37 | 22 | 59 |
| 2015 Fevereiro | 41 | 26 | 67 |
| 2015 Janeiro | 87 | 58 | 145 |
| 2014 Dezembro | 99 | 66 | 165 |
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