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SUMMARY OF THESIS* DIAS JUNIOR, Leonidas Braga - Hepatopatias fulminantes/febres hemorragicas na Amazonia: revisao historica, padroes de lesao hepaticae diagnostico etiologico. Sao Paulo, 2005. (Tese de Doutoramento - Faculdade de Medicina da Universidade de Sao Paulo). FULMINANT HEPATIC FAILURE/HEMORRHAGIC FEVER IN AMAZON BASIN: HISTORICAL REVIEW,HEPATIC DAMAGE PATTERNS AND ETIOLOGICAL DIAGNOSIS This study aimed at assessing morphological andimmunohistochemical aspects useful for the differential diagnosis ofyellow fever (YF), Labrea hepatitis (LH) and other entities by revisiting42 fulminant hepatic failure cases, from three historical series fromAmazon Basin. Additional studies were performed aiming at furtherunderstanding the morphogenesis of hepatocellular death, in relationto regeneration and fibrosis patterns and to vascular lesions, as recentlydescribed in chronic hepatic diseases. Among the extensive panel ofhistological criteria studied, liver cell death pattern and distribution,including midzonal apoptotic bodies, as well as hepatocellularballooning degeneration were YF most characteristic findings, whilemorula cells were the major hint for LH. Five cases were hereinsuggested as co-infected with YF, HBV and/or HDV, a finding notpreviously reported. Nineteen well characterized cases (10 YF and 9LH) were further submitted to immunohistochemical studies for YFantigen, HBsAg and Delta virus Ag. In both diseases, but mainly inLH, phlebitis, mainly of portal vein branches, was evident and closelyrelated to the degree of hepatocellular damage, with severe hepaticparenchymal extinction and portal tract approximation. Regenerationpattern was also remarkable: in YF cases, a high hepatocellularproliferative index was detected whereas in LH, multinucleation andpseudo-acinar transformation, associated with portal type I collagenand elastic fiber deposition were found. In conclusion,immunohistochemical viral antigen detection yielded further etiologicalcharacterization of these important historical cases of fulminant hepaticfailure from Amazon Basin, even in paraffin samples stored for up toseven decades. YF morphology depicted midzonal apoptosis, portalphlebitis and a high hepatocellular proliferative index, in patientswithout evidence of previous hepatic injury. On the other hand,fulminant LH showed extensive lytic hepatocellular necrosis, portaland hepatic vein phlebitis and the presence morula cells, in patientswith morphological evidences of chronic liver disease.Leonidas Braga Dias JuniorAv. Braz de Aguiar 9966035-000 Belem, Para, Brasilleonidas@supridad.com.br

Fulminant hepatic failure/hemorrhagic fever in Amazon Basin: historical review, hepatic damage patterns and etiological diagnosis