Odontogenic Tumor - Viva Questions & Answers

ls /home/daytona/workspace/ 2>/dev/null || mkdir -p /home/daytona/workspace

~/odontogenic_tumor_viva.py

from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import mm
from reportlab.lib import colors
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether
)
from reportlab.lib.enums import TA_LEFT, TA_CENTER, TA_JUSTIFY

OUTPUT = "/home/daytona/workspace/Odontogenic_Tumor_Viva.pdf"

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    rightMargin=18*mm, leftMargin=18*mm,
    topMargin=18*mm, bottomMargin=18*mm,
    title="Odontogenic Tumor - Viva Questions & Answers",
    author="Orris Medical"
)

styles = getSampleStyleSheet()

# Custom styles
TEAL = colors.HexColor("#006B6B")
LIGHT_TEAL = colors.HexColor("#E0F4F4")
DARK = colors.HexColor("#1A1A2E")
ACCENT = colors.HexColor("#FF6B35")
BG_LIGHT = colors.HexColor("#F7FAFA")

title_style = ParagraphStyle(
    "Title", parent=styles["Title"],
    fontSize=20, textColor=TEAL,
    spaceAfter=4, spaceBefore=0,
    alignment=TA_CENTER, fontName="Helvetica-Bold"
)
subtitle_style = ParagraphStyle(
    "Subtitle", parent=styles["Normal"],
    fontSize=10, textColor=colors.grey,
    spaceAfter=8, alignment=TA_CENTER
)
h1_style = ParagraphStyle(
    "H1", parent=styles["Heading1"],
    fontSize=13, textColor=colors.white,
    spaceBefore=10, spaceAfter=4,
    fontName="Helvetica-Bold", backColor=TEAL,
    leftIndent=-4, rightIndent=-4,
    borderPadding=(4, 8, 4, 8),
)
h2_style = ParagraphStyle(
    "H2", parent=styles["Heading2"],
    fontSize=11, textColor=TEAL,
    spaceBefore=7, spaceAfter=3,
    fontName="Helvetica-Bold",
    borderPadding=(2, 0, 2, 0),
)
h3_style = ParagraphStyle(
    "H3", parent=styles["Heading3"],
    fontSize=10, textColor=DARK,
    spaceBefore=5, spaceAfter=2,
    fontName="Helvetica-BoldOblique",
)
body_style = ParagraphStyle(
    "Body", parent=styles["Normal"],
    fontSize=9.5, textColor=DARK,
    spaceAfter=3, spaceBefore=1,
    leading=13, alignment=TA_JUSTIFY,
    fontName="Helvetica"
)
bullet_style = ParagraphStyle(
    "Bullet", parent=styles["Normal"],
    fontSize=9.5, textColor=DARK,
    spaceAfter=2, spaceBefore=1,
    leading=13, leftIndent=12,
    bulletIndent=2, fontName="Helvetica",
    bulletText="\u2022"
)
sub_bullet_style = ParagraphStyle(
    "SubBullet", parent=styles["Normal"],
    fontSize=9, textColor=DARK,
    spaceAfter=1, spaceBefore=0,
    leading=12, leftIndent=24,
    bulletIndent=14, fontName="Helvetica",
    bulletText="\u25e6"
)
highlight_style = ParagraphStyle(
    "Highlight", parent=styles["Normal"],
    fontSize=9.5, textColor=DARK,
    spaceAfter=3, spaceBefore=2,
    leading=13, leftIndent=8, rightIndent=8,
    backColor=LIGHT_TEAL, borderPadding=(4, 6, 4, 6),
    fontName="Helvetica"
)
mnemonic_style = ParagraphStyle(
    "Mnemonic", parent=styles["Normal"],
    fontSize=9.5, textColor=colors.HexColor("#7B0000"),
    spaceAfter=3, spaceBefore=2,
    leading=13, leftIndent=8, rightIndent=8,
    backColor=colors.HexColor("#FFF3E0"),
    borderPadding=(4, 6, 4, 6),
    fontName="Helvetica-BoldOblique"
)

def H1(text): return Paragraph(text, h1_style)
def H2(text): return Paragraph(text, h2_style)
def H3(text): return Paragraph(text, h3_style)
def P(text): return Paragraph(text, body_style)
def B(text): return Paragraph(text, bullet_style)
def SB(text): return Paragraph(text, sub_bullet_style)
def HL(text): return Paragraph(text, highlight_style)
def MN(text): return Paragraph(text, mnemonic_style)
def SP(h=4): return Spacer(1, h*mm)
def HR(): return HRFlowable(width="100%", thickness=0.5, color=TEAL, spaceAfter=3*mm, spaceBefore=1*mm)

story = []

# Title
story += [
    SP(2),
    Paragraph("Odontogenic Tumors", title_style),
    Paragraph("Viva Questions & Answers | ENT / Oral & Maxillofacial Surgery", subtitle_style),
    Paragraph("Sources: Cummings Otolaryngology | Scott-Brown's ORL | KJ Lee's Essential Otolaryngology | Robbins Pathology", subtitle_style),
    HR(),
    SP(2),
]

# Q1 - Classification
story += [
    H1("Q1. What are Odontogenic Tumors? How are they classified?"),
    SP(2),
    P("Odontogenic tumors are neoplasms derived from the epithelial and mesenchymal components of the tooth-forming apparatus — dental lamina, enamel organ, dental papilla, and dental follicle. They range from hamartomas (odontoma) to benign neoplasms to malignant carcinomas."),
    SP(2),
    H2("WHO Classification (Modified)"),
]

cls_data = [
    ["Category", "Examples"],
    ["Epithelial only", "Ameloblastoma, Squamous odontogenic tumor (SOT),\nCalcifying epithelial odontogenic tumor (CEOT/Pindborg),\nAOT, KCOT, Calcifying cystic odontogenic tumor (CCOT)"],
    ["Mixed Epithelial + Mesenchymal", "Ameloblastic fibroma, Ameloblastic fibro-odontoma,\nOdontoma, Odontoameloblastoma"],
    ["Mesenchymal only", "Odontogenic myxoma, Cementoblastoma, Ossifying fibroma"],
    ["Malignant", "Malignant ameloblastoma, Ameloblastic carcinoma,\nClear cell odontogenic carcinoma, Malignant CEOT"],
]
cls_table = Table(cls_data, colWidths=[55*mm, 115*mm])
cls_table.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), TEAL),
    ("TEXTCOLOR", (0,0), (-1,0), colors.white),
    ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
    ("FONTSIZE", (0,0), (-1,-1), 9),
    ("BACKGROUND", (0,1), (-1,1), LIGHT_TEAL),
    ("BACKGROUND", (0,3), (-1,3), LIGHT_TEAL),
    ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#AAAAAA")),
    ("VALIGN", (0,0), (-1,-1), "TOP"),
    ("TOPPADDING", (0,0), (-1,-1), 4),
    ("BOTTOMPADDING", (0,0), (-1,-1), 4),
    ("LEFTPADDING", (0,0), (-1,-1), 6),
]))
story += [cls_table, SP(3)]

story += [
    H2("Most Common Odontogenic Tumors"),
    HL("<b>Odontoma</b> = most common overall (~1/3 of all OTs; considered a hamartoma).<br/><b>Ameloblastoma</b> = most common true neoplasm (as common as all other neoplasms combined)."),
    SP(3),
]

# Q2 - Ameloblastoma
story += [
    H1("Q2. Ameloblastoma — Complete Viva Answer"),
    SP(2),
    H2("Origin"),
    P("Neoplasm of the <b>enamel organ</b>, recapitulating cells for tooth crown development. Arises from lining of odontogenic cysts, reduced enamel epithelium, dental lamina rests, or epithelial rests of Malassez."),
    SP(2),
    H2("Subtypes (Clinical/Prognostic Classification)"),
    B("<b>Solid/Multicystic (Conventional)</b> — most common; most aggressive; M:F = 1.2:1; mean age 37 years"),
    B("<b>Unicystic</b> — 5–15% of all ameloblastomas; subtypes: luminal, intraluminal, intramural"),
    B("<b>Peripheral (extra-osseous)</b> — arises in gingival soft tissue; least aggressive"),
    B("<b>Desmoplastic</b> — more common in maxilla and anterior jaws; mixed radiolucent/radiopaque XR"),
    SP(2),
    H2("Site"),
    HL("<b>80% in mandible</b> (molar-ramus region most common). Mandible:Maxilla ratio ~5:1.<br/>Maxillary lesions are more dangerous — thin cortical barrier, proximity to skull base and orbit."),
    SP(2),
    H2("Radiographic Features"),
    B("<b>Small lesion:</b> Unilocular radiolucency with well-demarcated corticated borders"),
    B("<b>Large lesion:</b> \"Soap bubble\" or \"Honeycomb\" — multilocular radiolucency"),
    B("Root resorption of adjacent teeth in long-standing lesions"),
    B("Desmoplastic type: mixed radiolucent/radiopaque"),
    SP(2),
    H2("Histology — Vickers and Gorlin Features (KEY VIVA)"),
    MN("Mnemonic: Reverse Polarity Helps Surgical Visualisation (RP-HSV)\n— Reversed polarity | Palisading | Hyperchromatism | Stellate reticulum | Vacuolization (subnuclear)"),
    SP(2),
    B("<b>Reverse polarity</b> — nuclei of basal cells polarized AWAY from basement membrane (reversed from normal)"),
    B("<b>Palisading</b> of columnar basal cells"),
    B("<b>Hyperchromatism</b> of basal cell nuclei"),
    B("<b>Subnuclear vacuolization</b> of cytoplasm of basal cells"),
    B("<b>Stellate reticulum-like cells</b> above the basal layer — loosely aggregated, resembling developing tooth stellate reticulum"),
    SP(2),
    H3("Histologic Variants (pathologist interest; NO therapeutic significance):"),
    P("Follicular, Plexiform, Granular cell, Acanthomatous, Desmoplastic, Basal cell, Keratinizing"),
    SP(2),
    H2("Behavior (Gardner's Two Factors)"),
    B("(1) Ability to <b>infiltrate medullary (cancellous) bone</b> but relative inability to infiltrate compact bone"),
    B("(2) <b>Location</b> — near vital structures (orbit, skull base) = worst prognosis"),
    P("Dense cortical bone (inferior border mandible/ramus) = first-line barrier. Periosteum = backup barrier. Posterior maxilla is most dangerous — thin cortical plate, proximity to skull base; mortality up to 60% if recurs."),
    SP(2),
    H2("Treatment"),
    B("<b>Gold standard: En bloc resection with 1 cm margin</b> past radiographic limits of tumor"),
    B("Recurrence after adequate resection: 10–15%"),
    B("Simple enucleation alone: NOT standard of care (high recurrence — tumor infiltrates trabeculae)"),
    B("Unicystic <i>luminal/intraluminal</i>: conservative approach acceptable (enucleation + curettage)"),
    B("<b>Unicystic intramural type:</b> behaves like solid ameloblastoma — requires resection"),
    B("All maxillary lesions: aggressive radical treatment"),
    SP(3),
]

# Q3 - AOT
story += [
    H1("Q3. Adenomatoid Odontogenic Tumor (AOT) — \"The 2/3 Tumor\""),
    SP(2),
    MN("Rule of 2/3: 2/3 Female | 2/3 Maxilla (anterior) | 2/3 Associated with impacted CANINE | 2/3 in Teenagers (<20 yrs)"),
    SP(2),
    H2("Clinical Features"),
    B("Most common age: <b>&lt;20 years</b>; rare after 30"),
    B("<b>Female predominance</b>"),
    B("Site: <b>Anterior maxilla</b> — classically associated with unerupted/impacted canine"),
    B("Slow-growing, relatively asymptomatic"),
    SP(2),
    H2("Radiographic Features"),
    B("Unilocular radiolucency, well-demarcated, corticated border"),
    B("May contain <b>small calcifications</b> — key differentiator from dentigerous cyst"),
    B("Often in dentigerous relationship with impacted tooth"),
    SP(2),
    H2("Histology"),
    B("Spindle-shaped epithelial cells in <b>whorled masses or rosettes</b>"),
    B("Classic: <b>duct-like structures</b> lined by cuboidal or columnar cells"),
    B("Foci of amyloid in rosette areas; variable mineralized material"),
    SP(2),
    H2("Treatment"),
    HL("<b>Enucleation only</b> — very well encapsulated; no recurrence. Tooth can be retained for eventual eruption."),
    SP(3),
]

# Q4 - CEOT
story += [
    H1("Q4. Calcifying Epithelial Odontogenic Tumor (CEOT) — Pindborg Tumor"),
    SP(2),
    H2("Clinical Features"),
    B("Age: <b>30–50 years</b>"),
    B("<b>Mandible &gt; Maxilla</b> (opposite of AOT)"),
    B("Painless, slowly progressive swelling; associated with impacted teeth (~50%)"),
    SP(2),
    H2("Radiographic Features"),
    B("Radiolucent, well-demarcated; may be multilocular"),
    B("Classic: <b>\"Driven snow\" appearance</b> — scattered calcifications within radiolucency"),
    SP(2),
    H2("Histology — KEY VIVA"),
    B("Sheets of polyhedral epithelial cells with <b>nuclear pleomorphism</b> (benign!)"),
    B("Large areas of <b>amyloid-like extracellular material</b>"),
    B("<b>Liesegang ring calcifications</b> — concentric calcified rings"),
    HL("<b>Congo red staining positive</b> for amyloid material — pathognomonic finding"),
    SP(2),
    H2("Treatment"),
    B("Resection with small margin of normal bone"),
    B("Good prognosis; locally aggressive"),
    SP(3),
]

# Q5 - KCOT
story += [
    H1("Q5. Keratocystic Odontogenic Tumor (KCOT) / Odontogenic Keratocyst (OKC)"),
    SP(2),
    H2("Classification Controversy"),
    B("First described by <b>Philipsen in 1956</b>"),
    B("2005 WHO: reclassified as <b>tumor</b> (KCOT) due to neoplastic behavior"),
    B("2017 WHO: reverted to \"odontogenic keratocyst\"; but ICD-11 retains tumor classification"),
    SP(2),
    H2("Clinical Features"),
    B("Peak: <b>2nd and 3rd decades</b>"),
    B("<b>Mandible &gt; Maxilla</b>; mandibular 3rd molar area most common"),
    B("Swelling, pain, trismus, sensory deficits, infection; may be incidental finding"),
    SP(2),
    H2("Radiographic Features"),
    B("Unilocular or multilocular radiolucency"),
    B("Classic: <b>Scalloping</b> of borders; bowing of inferior border of mandible"),
    B("Well-defined, corticated borders"),
    SP(2),
    H2("Histology"),
    B("<b>Parakeratinized stratified squamous epithelium</b> — thin, uniform, 6–8 cell layers"),
    B("<b>Palisaded, hyperchromatic, columnar basal cells</b> with reversed polarity"),
    B("Flat epithelial-connective tissue interface — <b>no rete ridges</b>"),
    B("Daughter/satellite cysts in fibrous wall"),
    SP(2),
    H2("Recurrence (HIGH — key viva point)"),
    HL("Recurrence up to <b>62.5% with enucleation alone</b> (older reports). Modern rate with enucleation + curettage: &lt;10%."),
    SP(2),
    H3("Reasons for High Recurrence:"),
    B("Thin, fragile lining — tears during surgery leaving remnants"),
    B("Daughter/satellite cysts left behind"),
    B("Dental lamina rests in overlying mucosa"),
    B("Collagenase activity of cyst wall promoting bone resorption"),
    B("Prostaglandin-induced bone resorption"),
    B("Increased mitotic activity (supports neoplastic nature)"),
    SP(2),
    H2("Gorlin-Goltz Syndrome"),
    HL("<b>Multiple OKCTs</b> + Bifid rib + Calcified falx cerebri + Basal cell nevi (Nevoid Basal Cell Carcinoma Syndrome)<br/><b>Gene: PTCH1</b> mutation (tumor suppressor gene)"),
    SP(2),
    H2("Treatment"),
    B("Enucleation + aggressive curettage (peripheral ostectomy with rotary bur)"),
    B("<b>Carnoy's solution</b> applied to bony walls — destroys satellite cysts/lamina rests"),
    B("Marsupialization as adjunct for very large cysts prior to enucleation"),
    B("Resection for large/recurrent lesions"),
    SP(3),
]

# Q6 - CCOT
story += [
    H1("Q6. Calcifying Cystic Odontogenic Tumor (CCOT) — Gorlin Cyst"),
    SP(2),
    P("First described by <b>Gorlin et al. in 1962</b>. Also called the Gorlin cyst. Shares the cyst-vs-tumor nomenclature debate with KCOT."),
    SP(2),
    H2("Clinical Features"),
    B("Mean age: 4th decade; peak: 2nd–3rd decades"),
    B("Slight maxillary predominance; anterior jaws more common"),
    B("Commonly associated with <b>odontomas</b> (especially in young adults)"),
    SP(2),
    H2("Radiographic Features"),
    B("Usually unilocular radiolucency"),
    B("Mixed radiolucent/radiopaque when calcifications present — <b>\"snowdrifting\"</b> (peripherally located calcifications)"),
    SP(2),
    H2("Histology — KEY VIVA"),
    HL("<b>Ghost cells</b> = classic hallmark. Anucleate, eosinophilic shadow cells derived from odontogenic epithelium that may undergo dystrophic calcification.<br/>Note: Ghost cells are NOT pathognomonic — can occur in odontomas, ameloblastic fibro-odontomas, and ameloblastomas."),
    B("Ameloblastoma-like basal cell layer"),
    SP(2),
    H2("Treatment"),
    B("Purely cystic form: Enucleation"),
    B("Solid form (dentinogenic ghost cell tumor): Resection"),
    SP(3),
]

# Q7 - Odontoma
story += [
    H1("Q7. Odontoma"),
    SP(2),
    HL("<b>Most common odontogenic tumor overall.</b> Considered a hamartoma (not a true neoplasm)."),
    SP(2),
    H2("Two Types"),
    B("<b>Compound odontoma:</b> Multiple small, recognizable tooth-like structures (denticles) — organized pattern. Site: <b>Anterior jaws</b>. More common type."),
    B("<b>Complex odontoma:</b> Haphazard mass of enamel, dentin, cementum, pulp — no recognizable tooth structure. Site: <b>Posterior jaws</b>."),
    SP(2),
    H2("Radiograph"),
    B("Radiopaque mass with a thin surrounding <b>radiolucent halo</b>"),
    B("Compound: multiple small tooth-like radiopacities | Complex: amorphous radiopaque mass"),
    SP(2),
    H2("Treatment"),
    B("Enucleation — excellent prognosis; no recurrence"),
    SP(3),
]

# Q8 - Ameloblastic Fibroma
story += [
    H1("Q8. Ameloblastic Fibroma"),
    SP(2),
    B("Age: <b>&lt;30 years</b> (mean ~14 years); <b>male predominance</b>"),
    B("Site: <b>Posterior mandible</b> most common"),
    B("Radiolucent, unilocular or multilocular, well-demarcated"),
    H2("Histology"),
    B("Odontogenic epithelium within <b>primitive-appearing (cell-rich) ectomesenchyme</b> resembling dental papilla"),
    B("No dental hard tissue formation — unlike ameloblastic fibro-odontoma"),
    H2("Behavior"),
    HL("Can recur after conservative excision. May undergo <b>malignant transformation to ameloblastic fibrosarcoma</b>."),
    B("Treatment: Conservative excision with follow-up"),
    SP(3),
]

# Q9 - Odontogenic Myxoma
story += [
    H1("Q9. Odontogenic Myxoma"),
    SP(2),
    B("Purely <b>mesenchymal</b> odontogenic tumor — no epithelium"),
    B("Site: <b>Posterior mandible</b> most common; no capsule — infiltrates widely"),
    SP(2),
    H2("Radiograph — KEY VIVA"),
    HL("<b>\"Tennis racket\" pattern</b> — multilocular radiolucency with fine, intersecting bony septa arranged at right angles (90°). Also described as \"soap bubble\" or \"honeycomb.\""),
    SP(2),
    H2("Histology"),
    B("Stellate/spindle cells in loose <b>myxomatous (gelatinous) stroma</b>"),
    B("Resembles the dental papilla — supports odontogenic origin"),
    B("<b>No capsule</b> — explains infiltrative behavior and high recurrence with conservative treatment"),
    SP(2),
    H2("Treatment"),
    B("<b>Resection</b> (wide local excision) — high recurrence with enucleation/curettage"),
    SP(3),
]

# Q10 - Cementoblastoma
story += [
    H1("Q10. Cementoblastoma"),
    SP(2),
    HL("<b>Only true neoplasm of cementum.</b>"),
    SP(2),
    B("Age: usually <b>&lt;25 years</b>; slight male predominance"),
    B("Site: <b>Mandibular 1st molar root</b> most common"),
    B("<b>Tooth vitality PRESERVED</b> — mass is attached to root, tooth remains vital (distinguishes from other jaw lesions)"),
    B("<b>Pain present</b> — important distinguishing feature"),
    SP(2),
    H2("Radiograph — KEY VIVA"),
    HL("<b>Radiopaque mass fused to root</b> with a thin surrounding radiolucent halo. Root resorption present. Tooth vital."),
    SP(2),
    H2("Treatment"),
    B("<b>Extraction of tooth and tumor together</b> (tooth + attached tumor as one specimen) — recurrence if tooth left"),
    SP(3),
]

# Q11 - Summary Table
story += [
    H1("Quick-Reference Summary Table"),
    SP(2),
]

summary_data = [
    ["Tumor", "Age", "Site", "X-Ray", "Histology Hallmark", "Treatment"],
    ["Ameloblastoma\n(Solid/Multicystic)", "Mean 37 y\nM:F 1.2:1", "Mandible\nmolar-ramus\n(80%)", "Soap bubble/\nHoneycomb", "Reverse polarity,\nstellate reticulum,\nVickers-Gorlin", "En bloc resection\n1 cm margin"],
    ["AOT", "<20 y\nFemale", "Ant. maxilla\n(2/3 rule)", "Unilocular +\ncalcifications", "Duct-like structures,\nrosettes", "Enucleation only"],
    ["CEOT\n(Pindborg)", "30–50 y", "Mandible", "Driven snow\ncalcifications", "Liesegang rings,\namyloid, Congo red+", "Resection\nwith margin"],
    ["KCOT/OKC", "2nd–3rd\ndecade", "Mandible\n3rd molar", "Scalloping,\nbowing of\ninferior border", "Parakeratotic 6-8\nlayers, no rete\nridges, daughter cysts", "Enucleation +\ncurettage + Carnoy's"],
    ["CCOT\n(Gorlin cyst)", "4th decade\npeak 2–3rd", "Ant. jaws", "Mixed / snowdrift\ncalcifications", "Ghost cells,\nanucleate shadow\ncells", "Enucleation"],
    ["Odontoma", "Young", "Ant. (compound)\nPost. (complex)", "Radiopaque\n+ lucent halo", "Hamartoma —\nall tooth tissues\ndisorganized", "Enucleation"],
    ["Ameloblastic\nFibroma", "<30 y\nMale", "Post. mandible", "Radiolucent\nunilocular/\nmultilocular", "Epi + primitive\ncell-rich\nmesenchyme", "Conservative\nexcision"],
    ["Odontogenic\nMyxoma", "Any", "Post. mandible", "Tennis racket\n(right-angle septa)", "Myxoid stroma,\nno capsule,\nstellate cells", "Resection\n(wide excision)"],
    ["Cementoblastoma", "<25 y\nMale", "Mandible\n1st molar root", "Radiopaque mass\nFUSED to root\n+ lucent halo", "True cementum,\nroot resorption,\ntooth VITAL", "Extract tooth\n+ tumor together"],
]

col_widths = [28*mm, 20*mm, 24*mm, 28*mm, 42*mm, 32*mm]
sum_table = Table(summary_data, colWidths=col_widths, repeatRows=1)
sum_table.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), TEAL),
    ("TEXTCOLOR", (0,0), (-1,0), colors.white),
    ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
    ("FONTSIZE", (0,0), (-1,0), 8.5),
    ("FONTSIZE", (0,1), (-1,-1), 8),
    ("FONTNAME", (0,1), (-1,-1), "Helvetica"),
    ("BACKGROUND", (0,1), (-1,1), LIGHT_TEAL),
    ("BACKGROUND", (0,3), (-1,3), LIGHT_TEAL),
    ("BACKGROUND", (0,5), (-1,5), LIGHT_TEAL),
    ("BACKGROUND", (0,7), (-1,7), LIGHT_TEAL),
    ("BACKGROUND", (0,9), (-1,9), LIGHT_TEAL),
    ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#AAAAAA")),
    ("VALIGN", (0,0), (-1,-1), "TOP"),
    ("TOPPADDING", (0,0), (-1,-1), 3),
    ("BOTTOMPADDING", (0,0), (-1,-1), 3),
    ("LEFTPADDING", (0,0), (-1,-1), 4),
    ("RIGHTPADDING", (0,0), (-1,-1), 3),
    ("ALIGN", (0,0), (-1,0), "CENTER"),
]))
story += [sum_table, SP(4)]

# Q12 - Must-Know Points
story += [
    H1("Q11. \"Asked in Every Viva\" — Must-Know Points"),
    SP(2),
]

mustknow = [
    ("<b>Most common OT overall</b>", "Odontoma (hamartoma)"),
    ("<b>Most common true neoplasm</b>", "Ameloblastoma"),
    ("<b>\"2/3 tumor\"</b>", "Adenomatoid odontogenic tumor (AOT)"),
    ("<b>Liesegang rings + Congo red + Amyloid</b>", "CEOT (Pindborg tumor)"),
    ("<b>Ghost cells</b>", "CCOT (Gorlin cyst) / Dentinogenic ghost cell tumor"),
    ("<b>Reverse polarity of nuclei</b>", "Ameloblastoma — Vickers-Gorlin feature"),
    ("<b>Soap bubble / Honeycomb XR</b>", "Ameloblastoma (also odontogenic myxoma)"),
    ("<b>Tennis racket XR</b>", "Odontogenic myxoma (right-angle bony septa)"),
    ("<b>Radiopaque mass fused to root, vital tooth</b>", "Cementoblastoma"),
    ("<b>KCOT associated syndrome</b>", "Gorlin-Goltz syndrome (PTCH1 mutation) — multiple OKCTs + bifid rib + calcified falx + basal cell nevi"),
    ("<b>Carnoy's solution</b>", "Used as adjunct in KCOT to destroy satellite cysts"),
    ("<b>Highest recurrence rate</b>", "KCOT (up to 62.5% with enucleation alone)"),
    ("<b>Desmoplastic ameloblastoma XR</b>", "Mixed radiolucent/radiopaque — most atypical; anterior maxilla"),
    ("<b>Tumor with malignant potential</b>", "Ameloblastic fibroma → Ameloblastic fibrosarcoma"),
    ("<b>Only true cementum neoplasm</b>", "Cementoblastoma"),
    ("<b>Philipsen (1956)</b>", "First described OKC/KCOT"),
    ("<b>Gorlin et al. (1962)</b>", "First described CCOT (Gorlin cyst)"),
    ("<b>Gardner's two factors</b>", "Ameloblastoma behavior: (1) infiltrates cancellous not compact bone; (2) location"),
]

mk_data = [["Key Fact", "Answer"]] + mustknow
mk_table = Table(mk_data, colWidths=[70*mm, 104*mm])
mk_table.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), TEAL),
    ("TEXTCOLOR", (0,0), (-1,0), colors.white),
    ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
    ("FONTSIZE", (0,0), (-1,-1), 9),
    ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#AAAAAA")),
    ("VALIGN", (0,0), (-1,-1), "TOP"),
    ("TOPPADDING", (0,0), (-1,-1), 4),
    ("BOTTOMPADDING", (0,0), (-1,-1), 4),
    ("LEFTPADDING", (0,0), (-1,-1), 6),
    ("BACKGROUND", (0,1), (-1,1), LIGHT_TEAL),
    ("BACKGROUND", (0,3), (-1,3), LIGHT_TEAL),
    ("BACKGROUND", (0,5), (-1,5), LIGHT_TEAL),
    ("BACKGROUND", (0,7), (-1,7), LIGHT_TEAL),
    ("BACKGROUND", (0,9), (-1,9), LIGHT_TEAL),
    ("BACKGROUND", (0,11), (-1,11), LIGHT_TEAL),
    ("BACKGROUND", (0,13), (-1,13), LIGHT_TEAL),
    ("BACKGROUND", (0,15), (-1,15), LIGHT_TEAL),
    ("BACKGROUND", (0,17), (-1,17), LIGHT_TEAL),
]))
story += [mk_table, SP(4)]

# Footer note
story += [
    HR(),
    Paragraph("Orris Medical | Compiled from Cummings Otolaryngology, Scott-Brown's ORL, KJ Lee's Essential Otolaryngology, Robbins &amp; Kumar Basic Pathology", subtitle_style),
]

doc.build(story)
print(f"PDF created: {OUTPUT}")

cd /home/daytona/workspace && python odontogenic_tumor_viva.py