mkdir -p /home/daytona/workspace/mesothelioma-ppt && ls /home/daytona/workspace/…

~/mesothelioma-ppt/mesothelioma.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Mesothelioma: Pathology";
pres.author = "Orris Medical Education";

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// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 1 — TITLE
// ──────────────────────────────────────────────────────────────────────────────
let slide = pres.addSlide();
titleSlide(slide,
  "MESOTHELIOMA\nPathology",
  "A Comprehensive Review of Incidence, Etiology, Histopathology, Diagnosis, Staging & Management"
);

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 2 — TABLE OF CONTENTS
// ──────────────────────────────────────────────────────────────────────────────
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// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 3 — SECTION HEADER: EPIDEMIOLOGY
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
sectionHeader(slide, "01. EPIDEMIOLOGY", "Global Incidence & Disease Burden");

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 4 — EPIDEMIOLOGY FACTS
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
contentSlide(slide, "Epidemiology & Incidence", [
  "Malignant mesothelioma affects ~15,000 persons per year worldwide",
  "Most common primary pleural cancer (>90% originate in pleural cavity)",
  "Also affects peritoneum, pericardium, and tunica vaginalis (<10%)",
  "Universally fatal: median survival only 12 months",
  "Global incidence is growing, especially in developing regions",
  "## Age & Sex Distribution",
  "Predominantly affects males (4:1 male-to-female ratio)",
  "Typically presents in the 6th–8th decade of life",
  "Long latency period: 20–50 years after asbestos exposure",
  "## Geographic Distribution",
  "Highest incidence: Australia, UK, Belgium (legacy asbestos industries)",
  "Increasing in developing nations: Russia, China, Brazil, Kazakhstan still mine asbestos",
  "Cappadocia (Turkey): hotspot due to environmental erionite exposure",
]);

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 5 — SECTION HEADER: ETIOLOGY
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
sectionHeader(slide, "02. ETIOLOGY & PATHOGENESIS", "Asbestos, Fibers & Molecular Mechanisms");

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 6 — ASBESTOS TYPES
// ──────────────────────────────────────────────────────────────────────────────
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  "Asbestos Classification",
  "Amphibole Group (HIGH RISK)",
  [
    "Crocidolite — blue asbestos",
    "Amosite — brown asbestos",
    "Long, thin, sharp, rigid fibers",
    "Resistant to macrophage degradation",
    "Up to 100× more carcinogenic than serpentine",
    "Persist indefinitely in lung parenchyma",
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  "Serpentine Group (LOWER RISK)",
  [
    "Chrysotile — white asbestos",
    "Most widely used commercially (~95%)",
    "Curly, flexible fibers",
    "More biodegradable than amphiboles",
    "Still associated with mesothelioma risk",
    "Still actively used in some countries",
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// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 7 — WAVES OF EXPOSURE
// ──────────────────────────────────────────────────────────────────────────────
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// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 8 — PATHOGENESIS
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
contentSlide(slide, "Pathogenesis: Molecular Mechanisms", [
  "## Fiber-Induced Cellular Events",
  "Direct mesothelial cell damage by needle-like fibers → DNA double-strand breaks",
  "Generation of reactive oxygen species (ROS) → oxidative DNA damage",
  "Disorganization of cell-signaling pathways (growth factor receptors, kinase cascades)",
  "## Key Tumor Suppressor Gene Silencing",
  "BAP1 (BRCA1-associated protein-1) — most commonly mutated (~60%)",
  "CDKN2A/p16INK4A — cyclin-dependent kinase inhibitor 2A (homozygous deletion)",
  "NF2 (neurofibromin 2/merlin) — frequently mutated in mesothelioma",
  "## Genetic Predisposition",
  "Germline BAP1 mutations → BAP1 Tumor Predisposition Syndrome",
  "Increased risk: mesothelioma, uveal & cutaneous melanoma, renal cancer",
  "Present in ~1–2% of Europeans",
  "## Other Causative Agents",
  "Erionite (zeolite mineral) — Cappadocia, Turkey; structurally similar to asbestos",
  "Carbon nanotubes — finer than crocidolite; cause mesothelial changes in animals",
  "Thorium dioxide (Thorotrast) — radiocontrast used 1930s–1950s",
  "SV40 virus, radiation — controversial/unproven associations",
  "Cigarette smoking — NO role in mesothelioma development",
]);

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 9 — SECTION HEADER: MACROSCOPIC PATHOLOGY
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
sectionHeader(slide, "03. MACROSCOPIC PATHOLOGY", "Gross Pathological Appearance");

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 10 — GROSS PATHOLOGY
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
contentSlide(slide, "Gross Pathological Features", [
  "## Pleural Involvement Pattern",
  "Begins as multiple nodules or plaques on parietal pleura",
  "Nodules coalesce to form a continuous rind of tumor encasing the lung",
  "Tumor spreads from parietal → visceral pleura (opposite of metastatic cancers)",
  "Creates a thick, firm, white-gray tumor 'rind' (1–5 cm in depth)",
  "## Fissures & Structures Involved",
  "Obliterates pleural fissures as disease progresses",
  "May directly invade: lung parenchyma, chest wall, diaphragm, pericardium, mediastinum",
  "Contralateral pleura involved in advanced disease",
  "## Pleural Effusion",
  "Present in >50% at diagnosis — typically massive unilateral effusion",
  "Straw-colored or blood-tinged exudate",
  "Pleural fluid cytology positive in only ~25% — low diagnostic yield",
  "## Peritoneal Mesothelioma (Gross)",
  "Studded peritoneal surface; ascites common",
  "Can encage bowel loops creating 'wet' or 'dry' patterns",
  "Distant metastases (liver, lymph nodes) often clinically silent",
]);

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 11 — SECTION HEADER: HISTOLOGICAL SUBTYPES
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
sectionHeader(slide, "04. HISTOLOGICAL SUBTYPES", "WHO Classification of Malignant Mesothelioma");

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 12 — THREE HISTOLOGICAL SUBTYPES OVERVIEW
// ──────────────────────────────────────────────────────────────────────────────
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  { name: "EPITHELIOID", pct: "~60%", chars: ["Tubular, papillary, acinar, or solid growth patterns", "Polygonal cells with abundant cytoplasm", "Vesicular nuclei, prominent nucleoli", "Best prognosis", "Most responsive to treatment"], color: GREEN_SOFT },
  { name: "SARCOMATOID", pct: "~20%", chars: ["Spindle-shaped cells in fascicles", "No specific architecture", "Desmoplastic variant: dense fibrous stroma", "Lyrosarcomatoid — rare variant", "Worst prognosis"], color: RED_SOFT },
  { name: "BIPHASIC (Mixed)", pct: "~20%", chars: ["Both epithelioid AND sarcomatoid components", "Each component ≥10% to qualify", "Prognosis intermediate", "Higher sarcomatoid % → worse outcome", "IHC helps confirm both components"], color: YELLOW },
];
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// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 13 — EPITHELIOID SUBTYPE IN DETAIL
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
contentSlide(slide, "Epithelioid Mesothelioma — Detailed Pathology", [
  "## Architectural Growth Patterns",
  "Tubulopapillary: tubules lined by cuboidal cells with papillary projections",
  "Acinar/glandular: gland-like spaces simulating adenocarcinoma",
  "Solid: sheets of polygonal cells, minimal stroma",
  "Micropapillary: small papillae without fibrovascular cores (aggressive behavior)",
  "Adenomatoid: small glandular spaces (benign-looking, but malignant)",
  "## Cytological Features",
  "Cuboidal to polygonal cells with abundant pink cytoplasm",
  "Round vesicular nuclei with prominent nucleoli",
  "Mitotic figures present but variable",
  "Intranuclear inclusions occasionally seen",
  "## Key Differential Diagnoses",
  "Metastatic adenocarcinoma (lung, breast, GI, ovarian) — most important DD",
  "Reactive mesothelial hyperplasia — distinguished by demonstration of invasion",
  "Synovial sarcoma (biphasic type) — careful IHC panel needed",
]);

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 14 — SARCOMATOID SUBTYPE IN DETAIL
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
contentSlide(slide, "Sarcomatoid & Desmoplastic Mesothelioma", [
  "## Sarcomatoid Mesothelioma",
  "Spindle-shaped cells arranged in fascicles or storiform patterns",
  "Nuclei are hyperchromatic and pleomorphic",
  "Stroma varies from loose myxoid to dense collagenous",
  "Necrosis common in poorly differentiated tumors",
  "Often infiltrates chest wall — extensive local invasion",
  "## Desmoplastic Variant (rare, ~5%)",
  "Dense, paucicellular collagenous tissue with bland spindle cells",
  "Easily mistaken for fibrous pleuritis — diagnosis by exclusion",
  "Key features: 'storiform' (cartwheel) fibrosis, bland necrosis, chest wall invasion",
  "Absence of reactive-type inflammation",
  "Poor prognosis — median survival <6 months",
  "## Lymphohistiocytoid Variant",
  "Rich inflammatory infiltrate obscuring tumor cells",
  "Spindle/polygonal cells admixed with lymphocytes and histiocytes",
  "Must distinguish from lymphoma — IHC essential",
  "## Differential Diagnoses",
  "Solitary fibrous tumor, synovial sarcoma, fibrosarcoma, carcinosarcoma",
]);

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 15 — SECTION HEADER: IMMUNOHISTOCHEMISTRY
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
sectionHeader(slide, "05. IMMUNOHISTOCHEMISTRY", "IHC Panel for Mesothelioma Diagnosis");

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 16 — IHC TABLE
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
tableSlide(slide,
  "IHC Panel: Mesothelioma vs. Adenocarcinoma",
  ["Marker", "Mesothelioma", "Lung Adenocarcinoma", "Notes"],
  [
    ["Calretinin", "Positive ✓✓", "Negative", "Nuclear + cytoplasmic; most specific positive marker"],
    ["WT-1", "Positive ✓✓", "Negative", "Nuclear staining; strong mesothelial marker"],
    ["Mesothelin", "Positive ✓✓", "Positive (weak)", "Also expressed in ovarian CA"],
    ["CK5/6", "Positive ✓✓", "Negative/weak", "Squamoid differentiation marker"],
    ["D2-40 (podoplanin)", "Positive ✓✓", "Negative", "Highly sensitive for epithelioid type"],
    ["TTF-1", "Negative ✗", "Positive ✓✓", "Key marker for lung primary"],
    ["CEA (polyclonal)", "Negative ✗", "Positive ✓✓", "Strong expression in adenocarcinoma"],
    ["Napsin A", "Negative ✗", "Positive ✓✓", "Highly specific for lung primary"],
    ["MOC31 (EpCAM)", "Negative ✗", "Positive ✓✓", "Epithelial cell adhesion molecule"],
    ["BAP1 (lost)", "Loss of expression", "Retained", "Diagnostic of malignancy in mesothelial cells"],
  ]
);

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 17 — IHC INTERPRETATION PRINCIPLES
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
contentSlide(slide, "IHC Interpretation — Key Principles", [
  "## Diagnostic Strategy",
  "Minimum 2 positive mesothelial markers + 2 negative adenocarcinoma markers required",
  "No single marker is 100% specific — panels must be used",
  "BAP1 loss is diagnostic of MALIGNANCY in mesothelial cells (not just reactive)",
  "CDKN2A/p16 homozygous deletion by FISH: diagnostic of mesothelioma",
  "## BAP1 Immunohistochemistry",
  "BAP1 = nuclear deubiquitylase enzyme; loss of nuclear staining = BAP1 mutation",
  "Sensitivity: ~60% in epithelioid, ~10% in sarcomatoid mesothelioma",
  "Combined BAP1 IHC + CDKN2A FISH: sensitivity ~90%",
  "Highly useful when cytological diagnosis is needed",
  "## FISH for CDKN2A/p16",
  "Homozygous deletion of p16 is DIAGNOSTIC of mesothelioma",
  "Detected in ~60–80% of mesotheliomas",
  "Particularly valuable in cytological specimens (pleural fluid, brushings)",
  "Can be applied to cell blocks from pleural fluid",
  "## Special Stains",
  "PAS/Alcian Blue: mesothelioma cells produce hyaluronic acid (Alcian Blue+, PAS-)",
  "Mucin not present in true mesothelioma (vs. adenocarcinoma which is mucin+)",
]);

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 18 — SECTION HEADER: MOLECULAR PATHOLOGY
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
sectionHeader(slide, "06. MOLECULAR PATHOLOGY", "Genetics & Biomarkers in Mesothelioma");

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 19 — MOLECULAR GENETICS TABLE
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
tableSlide(slide,
  "Key Molecular Alterations in Mesothelioma",
  ["Gene/Pathway", "Alteration", "Frequency", "Clinical Significance"],
  [
    ["BAP1", "Somatic loss-of-function mutation", "~60% epithelioid", "Diagnostic (IHC loss); germline→ hereditary syndrome"],
    ["CDKN2A/p16", "Homozygous deletion", "~60–80%", "Diagnostic by FISH; target for CDK4/6 inhibitors"],
    ["NF2 (Merlin)", "Loss-of-function mutation", "~40–50%", "YAP pathway activation; therapeutic target"],
    ["LATS1/2", "Inactivation", "~20%", "Hippo pathway dysregulation; YAP/TAZ activation"],
    ["TP53", "Mutation", "~10–15%", "Less common than other cancers"],
    ["TERT", "Amplification/mutation", "~5%", "Telomere maintenance; poor prognosis"],
    ["PD-L1", "Overexpression", "Variable", "Checkpoint immunotherapy target"],
    ["VEGF", "Overexpression", "Common", "Drives angiogenesis; anti-VEGF targets studied"],
  ]
);

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 20 — SECTION HEADER: CLINICAL FEATURES
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
sectionHeader(slide, "07. CLINICAL FEATURES & DIAGNOSIS", "Presentation, Investigations & Biopsy");

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 21 — CLINICAL FEATURES
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
twoColumnSlide(slide,
  "Clinical Presentation",
  "Symptoms",
  [
    "Progressive exertional dyspnoea (most common)",
    "Non-pleuritic chest pain / chest wall pain",
    "Weight loss and fatigue",
    "Dry cough",
    "Sweating, fever (less common)",
    "Hoarseness, dysphagia (advanced)",
    "SVC obstruction syndrome (rare)",
    "Paraneoplastic syndromes rare",
  ],
  "Signs on Examination",
  [
    "Ipsilateral dullness to percussion",
    "Reduced breath sounds (effusion)",
    "Contraction of affected hemithorax",
    "Chest wall mass/nodule at drain sites",
    "Pleural rub (uncommon)",
    "Clubbing (rare)",
    "Pleural port site metastasis",
    "Distant metastases often clinically silent",
  ],
  ACCENT2, ACCENT
);

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 22 — DIAGNOSTIC PATHWAY
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
contentSlide(slide, "Diagnostic Pathway — Tissue Acquisition", [
  "## Pleural Fluid Analysis",
  "Cytology: positive in only ~25% — insufficient for definitive diagnosis",
  "Exudative effusion (Light's criteria met); often serosanguinous",
  "Cell block from pleural fluid: allows IHC and BAP1/FISH analysis",
  "## Closed Pleural Biopsy (Blind)",
  "Reverse-bevel needle biopsy: sensitivity only 21–43% — not recommended",
  "CT-guided percutaneous biopsy: sensitivity 25–60% — acceptable for poor performance status",
  "## Gold Standard: Video-Assisted Thoracoscopy (VATS)",
  "Definitive diagnosis requires histological proof of invasion",
  "VATS allows direct visualization and targeted biopsy",
  "Multiple biopsies from different areas recommended",
  "Concurrent talc pleurodesis can be performed",
  "## Pathological Diagnosis Challenges",
  "Separating reactive/hyperplastic mesothelium from malignant cells",
  "Demonstration of stromal invasion is key — often requires generous tissue sample",
  "Desmoplastic sarcomatoid mimics fibrous pleuritis",
  "BAP1 loss + CDKN2A FISH deletion = diagnostic combination in ambiguous cases",
]);

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 23 — SECTION HEADER: RADIOLOGY
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
sectionHeader(slide, "08. RADIOLOGICAL FEATURES", "CXR, CT, MRI & PET Findings");

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 24 — RADIOLOGY
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
contentSlide(slide, "Radiological Features in Mesothelioma", [
  "## Chest X-Ray",
  "Unilateral pleural effusion (massive) — most common initial finding",
  "Pleural thickening / pleural masses",
  "Volume loss / mediastinal shift toward affected side (trapped lung)",
  "## CT Chest (Primary Staging Modality)",
  "Circumferential irregular pleural thickening (>1 cm): highly suggestive",
  "Nodular pleural thickening, especially involving mediastinal pleura",
  "Obliteration of pleural fissures; invasion of diaphragm/chest wall",
  "CT features similar to other malignant pleural diseases — not pathognomonic",
  "Asbestos-related findings: pleural plaques, calcification, parenchymal fibrosis",
  "## MRI",
  "Superior for T staging — better soft tissue resolution (chest wall, diaphragm, pericardium)",
  "Demonstrates invasion of adjacent structures better than CT",
  "## PET/CT",
  "FDG-avid: diffuse strong uptake on affected pleural surface",
  "Useful to differentiate malignant from benign pleural disease (accuracy >90%)",
  "Higher number of mediastinal nodes + distant metastases detected vs CT alone",
  "MTV (metabolic tumor volume) on PET: predictive of overall survival",
  "Pitfall: false positive after talc pleurodesis (inflammatory FDG uptake)",
]);

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 25 — SECTION HEADER: STAGING
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
sectionHeader(slide, "09. TNM STAGING", "IMIG/AJCC Staging System for Pleural Mesothelioma");

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 26 — TNM STAGING TABLE
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
tableSlide(slide,
  "TNM Staging — Malignant Pleural Mesothelioma (IMIG/AJCC)",
  ["Stage", "T", "N", "M", "Description"],
  [
    ["IA", "T1a", "N0", "M0", "Ipsilateral parietal pleura only; no visceral involvement"],
    ["IB", "T1b", "N0", "M0", "Ipsilateral parietal + foci on visceral pleura"],
    ["II", "T2", "N0", "M0", "Visceral pleura + diaphragm or parenchyma involved"],
    ["IIIA", "T3", "N0", "M0", "Locally advanced but potentially resectable (fascia/fat/soft tissue)"],
    ["IIIB", "T1–3", "N1–2", "M0", "Mediastinal/contralateral lymph nodes; or any T with N1"],
    ["IV", "T4 any", "any N", "M1", "Diffusely invasive / distant metastases → unresectable"],
  ]
);

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 27 — SECTION HEADER: TREATMENT
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
sectionHeader(slide, "10. TREATMENT & PROGNOSIS", "Multimodal Approach & Survival Data");

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 28 — SYSTEMIC THERAPY
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
contentSlide(slide, "Systemic Therapy — Current Standards", [
  "## First-Line Chemotherapy (Platinum-Based)",
  "Cisplatin + Pemetrexed: standard first-line since 2003; median OS ~12.1 months",
  "Addition of Bevacizumab (anti-VEGF): improves OS to ~18.8 months (MAPS trial)",
  "Carboplatin + Pemetrexed: for patients unfit for cisplatin",
  "## Immunotherapy (First-Line, Unresectable)",
  "Nivolumab + Ipilimumab (CheckMate 743): FDA approved 2020",
  "OS benefit over chemotherapy: 18.1 vs 14.1 months (non-epithelioid benefit most striking)",
  "Pembrolizumab: approved as monotherapy in second-line setting",
  "## Second-Line Options",
  "Vinorelbine or Gemcitabine: modest activity in platinum-refractory disease",
  "Pembrolizumab or Nivolumab: approved in second-line (PD-L1 positive)",
  "Clinical trial participation strongly encouraged at all lines",
  "## Targeted Therapy (Investigational)",
  "YAP/TAZ pathway inhibitors (NF2/LATS mutations)",
  "CDK4/6 inhibitors (p16 loss)",
  "Anti-mesothelin therapies (amatuximab, CAR-T cells)",
]);

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 29 — SURGERY & RADIATION
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
twoColumnSlide(slide,
  "Surgery & Radiation Therapy",
  "Surgical Options",
  [
    "NO PROVEN ROLE for radical curative resection",
    "Extrapleural Pneumonectomy (EPP): removes lung + visceral pleura + diaphragm + pericardium",
    "MARS trial: EPP HARMFUL — shortened survival by 5 months (HR 2.75)",
    "EPP should NOT be recommended to patients",
    "Extended Pleurectomy/Decortication (P/D): lung-sparing debulking",
    "Meso-VATS: parietal pleurectomy + talc pleurodesis vs talc alone — debulking arm better QoL",
  ],
  "Radiation Therapy",
  [
    "Prophylactic PORT: 3× 7 Gy to drain sites — reduces port-site seeding",
    "SMART (Surgery for Mesothelioma After Radiation): preop hemithoracic RT + EPP in selected patients",
    "Palliative RT: effective for pain control in chest wall invasion",
    "Intensity-modulated RT (IMRT): spares contralateral lung",
    "Role remains investigational in definitive management",
  ],
  RED_SOFT, ACCENT2
);

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 30 — PROGNOSIS
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: DARK_BG } });
slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.75, fill: { color: MID_BG } });
slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.055, fill: { color: ACCENT } });
slide.addText("Prognosis & Survival Predictors", {
  x: 0.3, y: 0.08, w: 9.4, h: 0.65, fontSize: 20, bold: true, color: ACCENT, fontFace: "Calibri"
});
// Survival boxes
const prognosisData = [
  { label: "Epithelioid", survival: "~18–24 mo", color: GREEN_SOFT },
  { label: "Biphasic", survival: "~12–14 mo", color: YELLOW },
  { label: "Sarcomatoid", survival: "~4–6 mo", color: RED_SOFT },
];
prognosisData.forEach((p, i) => {
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  slide.addText(p.survival, { x: 0.3 + i * 3.2, y: 1.35, w: 3.0, h: 1.3, fontSize: 24, bold: true, color: p.color, fontFace: "Calibri", align: "center", valign: "middle" });
});
// Prognostic factors
slide.addText([
  { text: "Favorable Factors:", options: { bold: true, color: GREEN_SOFT, fontSize: 13, breakLine: true } },
  { text: "Epithelioid histology  •  Stage I–II  •  Age <65  •  Female sex  •  No weight loss  •  PS 0–1  •  Normal Hb  •  Localized disease  •  Right-sided tumor", options: { color: LIGHT_TXT, fontSize: 12, breakLine: true } },
  { text: "\nUnfavorable Factors:", options: { bold: true, color: RED_SOFT, fontSize: 13, breakLine: true } },
  { text: "Sarcomatoid histology  •  Stage III–IV  •  Weight loss  •  Poor PS  •  Elevated LDH/WBC  •  Thrombocytosis  •  Male sex  •  Peritoneal spread", options: { color: LIGHT_TXT, fontSize: 12 } },
], { x: 0.3, y: 2.85, w: 9.4, h: 2.5, fontFace: "Calibri", valign: "top", paraSpaceAfter: 3 });

// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 31 — KEY POINTS / SUMMARY
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: DARK_BG } });
slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.75, fill: { color: MID_BG } });
slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.055, fill: { color: ACCENT } });
slide.addText("KEY POINTS — Summary", {
  x: 0.3, y: 0.08, w: 9.4, h: 0.65, fontSize: 20, bold: true, color: ACCENT, fontFace: "Calibri"
});
const keyPoints = [
  "Mesothelioma is a universally fatal primary serosal malignancy; >90% affect the pleura",
  "Asbestos (especially amphibole: crocidolite & amosite) is the dominant cause; latency 20–50 years",
  "Three histological subtypes: epithelioid (~60%), sarcomatoid (~20%), biphasic (~20%)",
  "Epithelioid has best prognosis; sarcomatoid worst; IHC panel (calretinin, WT-1, D2-40, BAP1 loss) is essential",
  "BAP1 loss + CDKN2A/p16 homozygous deletion (FISH) = most reliable diagnostic combination",
  "CT chest is primary staging tool; PET/CT improves accuracy for nodal/metastatic disease",
  "VATS biopsy is gold standard; cytology alone insufficient (only 25% positive)",
  "EPP is harmful and should not be performed (MARS trial: HR 2.75 vs. no surgery)",
  "First-line: Cisplatin + Pemetrexed ± Bevacizumab OR Nivolumab + Ipilimumab (CheckMate 743)",
  "Overall median survival 12 months; no curative therapy exists — palliation is paramount",
];
slide.addText(keyPoints.map((k, i) => ({
  text: `${i + 1}.  ${k}`,
  options: { color: LIGHT_TXT, fontSize: 11.5, breakLine: i < keyPoints.length - 1 }
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// ──────────────────────────────────────────────────────────────────────────────
//  SLIDE 32 — CLOSING SLIDE
// ──────────────────────────────────────────────────────────────────────────────
slide = pres.addSlide();
slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: DARK_BG } });
slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.25, h: 5.625, fill: { color: ACCENT } });
slide.addShape(pres.ShapeType.rect, { x: 0, y: 4.8, w: 10, h: 0.15, fill: { color: ACCENT } });
slide.addShape(pres.ShapeType.ellipse, { x: 7.5, y: -1.2, w: 4.5, h: 4.5, fill: { color: "1A3550" }, line: { color: ACCENT2, width: 2 } });
slide.addText("Thank You", {
  x: 0.6, y: 1.4, w: 8.5, h: 1.0, fontSize: 38, bold: true, color: WHITE, fontFace: "Calibri", align: "left"
});
slide.addText("References", {
  x: 0.6, y: 2.5, w: 8, h: 0.4, fontSize: 14, bold: true, color: ACCENT, fontFace: "Calibri", align: "left"
});
slide.addText([
  { text: "1. Murray & Nadel's Textbook of Respiratory Medicine, 2-Volume Set — Chapter 114: Malignant Pleural Disease", options: { color: LIGHT_TXT, fontSize: 11, breakLine: true } },
  { text: "2. Fishman's Pulmonary Diseases and Disorders, 2-Volume Set — Chapter 30: Nuclear Medicine Imaging", options: { color: LIGHT_TXT, fontSize: 11, breakLine: true } },
  { text: "3. Goldman-Cecil Medicine International Edition, 2 Volume Set — Chapter on Pleural Diseases", options: { color: LIGHT_TXT, fontSize: 11, breakLine: true } },
  { text: "4. Baas P, et al. (2021). First-line nivolumab plus ipilimumab in unresectable malignant pleural mesothelioma. Lancet Oncol.", options: { color: LIGHT_TXT, fontSize: 11, breakLine: true } },
  { text: "5. Muers MF, et al. MARS trial (2011). EPP versus no EPP in mesothelioma. Lancet Oncol.", options: { color: LIGHT_TXT, fontSize: 11 } },
], { x: 0.6, y: 2.95, w: 9.0, h: 2.3, fontFace: "Calibri", valign: "top", paraSpaceAfter: 5 });

// ─── WRITE FILE ─────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/mesothelioma-ppt/Mesothelioma_Pathology.pptx" })
  .then(() => console.log("SUCCESS: Mesothelioma_Pathology.pptx written"))
  .catch(err => { console.error("ERROR:", err); process.exit(1); });

cd /home/daytona/workspace/mesothelioma-ppt && node mesothelioma.js

ls -lh /home/daytona/workspace/mesothelioma-ppt/Mesothelioma_Pathology.pptx