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Gravida 1 Para 1(1001) Mild Anemia Secondary To Acute Blood Loss - Corrected Abnormal Uterine Bleeding Secondary To Endometrial Polyp Pelvic Endometriosis Stage IV Ovarian Abscess by Frozen Section Biopsy I have a case presentation from this Gyne case i have no idea how to proceed please guide me to include what as the main diagnosis why was the surgery done how did they come up with the diagnosis differential and management

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endometriosis stage IV total abdominal hysterectomy bilateral salpingo-oophorectomy

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Case Presentation Guide: Gynecologic Case

Patient: 43-year-old, G1P1 (1001), Married Chief Complaint: Intermenstrual Spotting Procedure Date: June 24, 2026 - Brokenshire Medical Center, Davao City

1. PATIENT IDENTIFICATION AND OBSTETRIC CODE

G1P1 (1001) means:

G1 = 1 pregnancy total
P1 = 1 delivery (term: 1, preterm: 0, abortus/miscarriage: 0, living children: 1)

2. MAIN DIAGNOSIS (Post-Operative)

The post-operative diagnoses are listed as a cluster - there is no single "main" diagnosis because they are interconnected. However, for presentation purposes, the primary working diagnosis driving surgical intervention was:

Pelvic Endometriosis Stage IV with Bilateral Ovarian Endometriomas (Ovarian Abscess by Frozen Section), complicated by Abnormal Uterine Bleeding secondary to Endometrial Polyp

Why "Stage IV"? The revised American Society for Reproductive Medicine (rASRM) classification stages endometriosis I-IV based on the appearance, size, depth of peritoneal/ovarian implants, presence of adnexal adhesions, and degree of cul-de-sac obliteration. Stage IV (score >40) represents the most severe form. In this patient:

Bilateral ovarian masses (right 11cm, left 10cm) - both unilocular cystic with thickened capsules
Dense adhesions: right ovary adherent to pelvic sidewall, omentum, rectosigmoid, and posterior corpus
Uterus enlarged to 12 weeks size
Extensive adhesiolysis and enterolysis required intraoperatively All of these features are hallmarks of Stage IV disease. (Berek & Novak's Gynecology)

3. WHY WAS SURGERY DONE?

The patient was 43 years old, para 1 (completed family), presenting with progressive and complex gynecologic disease that had failed or was not appropriate for conservative management. The indications for Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy (TAH-BSO) were:

Indication	Rationale
Stage IV endometriosis with bilateral ovarian masses	Suspected bilateral endometriomas/abscess; masses were 10-11cm, densely adherent, with thick capsules - cannot be managed medically
Abnormal uterine bleeding secondary to endometrial polyp	Structural cause (AUB-P in PALM-COEIN), requires definitive treatment
Age 43, completed family	TAH-BSO offers best chance of cure for Stage IV endometriosis in this demographic
Concern for malignancy	Admitting diagnosis stated "Ovarian New Growth Bilateral Probably Malignant" - frozen section was required intraoperatively to rule out cancer
Bilateral ovarian abscess confirmed on frozen section	Once ovarian abscess was confirmed, removal was both curative and necessary to control infection
Uterus enlarged (12 weeks) with AUB + anemia	Structural cause requiring definitive surgical management

Bailey and Love's Surgery states: "For a woman who has completed her family, hysterectomy plus bilateral salpingo-oophorectomy with total excision of endometriotic disease offers a good chance of cure."

The surgery was also significantly more complex than planned - the right ovarian mass inadvertently ruptured during adhesiolysis, releasing grayish-green foul fluid (consistent with ovarian abscess), requiring intraoperative referral to the General Surgery department and proceeding with appendectomy as well.

4. HOW DID THEY ARRIVE AT THE DIAGNOSIS?

Step 1 - Chief Complaint

Intermenstrual spotting - bleeding between periods. This is a classic presentation of an endometrial polyp (AUB-P) and can also be seen with endometriosis. (Berek & Novak's Gynecology)

Step 2 - Workup Leading to Admitting Diagnosis

The admitting diagnosis included "AUB secondary to Endometrial Polyps vs Endometrial Pathology" and "Ovarian New Growth Bilateral - Probably Malignant." This means the team likely performed:

Pelvic examination: Fixed retroverted uterus, enlarged uterus, tender/enlarged ovaries suggest endometriosis. Palpable pelvic mass on bimanual exam.
Transvaginal ultrasound (TVUS): The gold standard first-line imaging. Likely showed:
- Bilateral adnexal masses (which turned out to be 10-11cm ovarian cysts with thickened capsules)
- Endometrial thickening or hyperechoic focus suggesting a polyp (confirmed as 1cm × 0.5cm polyp on cut section)
Endometrial sampling / office biopsy or D&C: Indicated to rule out hyperplasia or malignancy given her age (>45 threshold is standard; she is 43 but had risk factors). Polyp was likely visualized by sonohysterography or suspected on TVUS.
CBC: Confirmed mild anemia secondary to acute blood loss from the AUB.
CA-125 / tumor markers: Likely ordered given the bilateral adnexal masses described as "probably malignant" - elevated CA-125 supports endometriosis but also raises concern for ovarian malignancy.
MRI pelvis: May have been done to map deep endometriosis extent.

The diagnosis of endometrial polyp requires: TVUS showing endometrial thickening > sonohysterography/hysteroscopy visualizing the polyp > histologic confirmation. Cut section confirmed: 1cm × 0.5cm endometrial polyp, endometrium 0.2cm thin.

Step 3 - Intraoperative and Frozen Section

On laparotomy, bilateral ovarian masses were found - both unilocular cystic, smooth thickened external capsule, densely adherent
Cut section showed red-brown internal capsule with rough inner walls - classic gross appearance of an endometrioma ("chocolate cyst")
The right mass ruptured during dissection releasing grayish-green foul fluid - not the typical "chocolate" fluid of an endometrioma; this indicated superimposed infection/abscess formation
Frozen section biopsy was sent intraoperatively and returned: Ovarian Abscess (not malignancy) - this was critical because it guided the surgical team's decision and ruled out cancer

5. DIFFERENTIAL DIAGNOSES

For the key presentations in this case:

For Bilateral Adnexal Masses (Large, 10-11cm, Bilateral)

Differential	Features Supporting	Features Against
Bilateral Endometriomas (Endometriosis)	Dense adhesions, chocolate-brown fluid, thickened capsule, Stage IV findings, uterosacral involvement	Grayish-green fluid (suggests infection)
Ovarian Abscess / Tubo-ovarian abscess	Foul grayish-green fluid on rupture, dense adhesions to bowel, confirmed on frozen section	Usually unilateral; bilateral is less common
Ovarian Malignancy (Primary)	Bilateral, large, thickened capsule, irregular walls on cut section, elevated concern preop	Frozen section showed no malignancy
Mucinous Cystadenoma	Can be large, cystic, bilateral	Usually not densely adherent; no infectious fluid
Serous Cystadenoma	Bilateral, smooth	Usually thin-walled, not densely adherent

For Abnormal Uterine Bleeding (Intermenstrual Spotting, 43y/o)

Using the PALM-COEIN classification (Sabiston Surgery; Berek & Novak's Gynecology):

Category	Diagnosis	In This Patient
P - Polyp	Endometrial polyp	CONFIRMED (1cm polyp on cut section)
A - Adenomyosis	Adenomyosis	Uterus was enlarged to 12wks; possible concurrent finding
L - Leiomyoma	Fibroids	Not reported intraoperatively
M - Malignancy	Endometrial carcinoma	Ruled out (endometrium thin 0.2cm, smooth)
C - Coagulopathy	Bleeding disorders	Unlikely in this context
O - Ovulatory dysfunction	PCOS, perimenopausal	Possible at age 43
E - Endometrial	Endometritis	Possible concurrent finding

6. MANAGEMENT SUMMARY

Pre-Operative

Correction of anemia (the admitting diagnosis states "Mild Anemia Secondary to Acute Blood Loss - Corrected" by time of surgery)
Optimization of surgical fitness
Bowel prep given likely bowel adhesions (rectosigmoid involvement)
Intraoperative General Surgery referral on standby (performed)

Surgical (What was Done and Why)

Procedure	Reason
Exploratory Laparotomy	Bilateral pelvic masses, cannot fully evaluate laparoscopically given extent of adhesions
Extensive Adhesiolysis + Enterolysis	Dense adhesions of ovary to pelvic sidewall, omentum, rectosigmoid; required bowel separation (enterolysis)
Total Abdominal Hysterectomy	AUB with endometrial polyp, Stage IV endometriosis, uterus 12-weeks enlarged, completed family
Bilateral Salpingo-Oophorectomy	Bilateral ovarian masses (abscess confirmed), eliminates estrogen source driving endometriosis, curative intent
Appendectomy	Performed by Surgery - likely because of proximity to infected mass, possible involvement or prophylaxis during infected field dissection
Frozen Section Biopsy	Urgent intraoperative pathology to rule out malignancy before proceeding with BSO
Peritoneal Washing	Standard for hemostasis and irrigation in infected/endometriotic pelvis

Anesthesia: Combined Spinal-Epidural (CSE) - appropriate for major pelvic surgery; provides excellent intraoperative block and post-operative analgesia via epidural catheter.

Blood Loss: 900cc - significant, likely requiring monitoring and possible transfusion. Consistent with the complexity of the case (dense adhesions, bilateral large masses, inadvertent rupture).

Post-Operative

Specimens sent for histopathology: Uterus, Cervix, bilateral Fallopian tubes and Ovaries - final histology will confirm diagnosis and rule out malignancy definitively
Antibiotic therapy for confirmed ovarian abscess
Wound care, DVT prophylaxis, early mobilization
Hormone replacement therapy counseling (surgical menopause at age 43 after BSO)

7. FROZEN SECTION BIOPSY - Why It Was Done

A frozen section is an intraoperative rapid pathology technique where tissue is snap-frozen, sectioned, and examined by a pathologist within 15-30 minutes while the patient is still on the operating table. It was done here because:

The masses were described preoperatively as "probably malignant"
When the right ovarian mass ruptured and released grayish-green foul-smelling fluid (not typical chocolate cyst fluid), the diagnosis became uncertain
The surgeons needed to know whether this was malignancy, endometrioma, or abscess before deciding the extent of resection
Result: Ovarian Abscess - confirmed benign, appropriate to proceed with BSO without further staging procedures

8. KEY PATHOLOGIC CORRELATION

Finding	Gross Description	Significance
Endometrial polyp	1cm × 0.5cm on cut section	Source of intermenstrual spotting (AUB-P)
Thin endometrium (0.2cm)	Smooth and thin	Rules out endometrial hyperplasia/malignancy
Bilateral ovarian cysts	Red-brown internal capsule, rough inner walls	Classic endometrioma appearance
Grayish-green foul fluid	On rupture of right ovarian mass	Secondary infection/abscess superimposed on endometrioma
Dense adhesions to rectosigmoid, pelvic wall	Intraoperative finding	Stage IV endometriosis
Uterus 12-weeks size	Enlarged	Likely from adenomyosis or endometriosis involvement

9. LEARNING POINTS FOR THE CASE PRESENTATION

Stage IV endometriosis is a surgical disease in a patient who has completed childbearing - TAH-BSO is the definitive treatment
Endometrial polyps are a structural cause of AUB (PALM-COEIN: AUB-P) diagnosed by TVUS + hysteroscopy/sonohysterography + histology
Endometriomas can become superinfected forming ovarian abscesses - the red-brown chocolate cyst fluid turns purulent/foul-smelling
Frozen section is a critical intraoperative tool to guide surgical decision-making when malignancy cannot be excluded preoperatively
Intermenstrual spotting in a woman in her 40s warrants thorough evaluation with TVUS, endometrial sampling, and consideration of endometriosis workup
Obstetric code 1001 = 1 term birth, 0 preterm, 0 abortus, 1 living child

Sources:

Bailey and Love's Short Practice of Surgery, 28th Edition - Endometriosis management
Berek & Novak's Gynecology - AUB/PALM-COEIN, Endometriosis staging (rASRM), Tubo-ovarian abscess
Robbins & Kumar Basic Pathology - Endometriosis pathogenesis, AUB causes
Sabiston Textbook of Surgery - AUB workup and surgical optionsHere is a complete breakdown of everything you need for this case presentation:

Quick Summary of the Whole Case

This is a 43-year-old G1P1 admitted for intermenstrual spotting, who turned out to have three major gynecologic problems happening simultaneously:

An endometrial polyp causing the spotting (AUB-P)
Stage IV pelvic endometriosis with bilateral massive ovarian cysts (10-11cm)
Bilateral ovarian abscesses - the endometriomas became superinfected

Because she was 43 with a completed family, and had bilateral large infected masses plus AUB with an 11cm uterus, the decision was made to do a Total Abdominal Hysterectomy + Bilateral Salpingo-Oophorectomy + Appendectomy under Combined Spinal-Epidural anesthesia. The frozen section was done intraoperatively to rule out cancer before committing to BSO.

How to Structure Your Case Presentation

1. Chief Complaint: Intermenstrual spotting

2. Admitting Diagnosis: Use all four diagnoses in the record as a cluster - explain each one (the guide above breaks each down)

3. Main Diagnosis: For presentation, lead with Pelvic Endometriosis Stage IV as the primary diagnosis driving surgery, with AUB-P (endometrial polyp) and ovarian abscess as co-diagnoses

4. Diagnosis - how they arrived at it: TVUS showing bilateral adnexal masses + endometrial polyp on imaging → endometrial sampling → preop concern for malignancy → intraoperative frozen section confirmed benign ovarian abscess

5. Differentials: Use the PALM-COEIN table for AUB, and the bilateral adnexal mass differential table above

6. Why surgery: Age, completed family, bilateral large masses, confirmed infection, structural AUB - all pointing to TAH-BSO as definitive treatment

7. Management: Walk through each procedure performed and justify it (the table in Section 6 above gives you this)

If you need this formatted as a written case report, a PowerPoint presentation, or want help writing a specific section (e.g., discussion or impression), just let me know.

I already provided a full detailed guide for this case in my previous response above. Here is a quick recap of all the key sections so you can use it directly:

YOUR CASE PRESENTATION - COMPLETE GUIDE

PATIENT PROFILE

43-year-old, G1P1 (1001), married
G1P1 (1001) = 1 pregnancy, 1 term birth, 0 preterm, 0 abortus, 1 living child
Chief Complaint: Intermenstrual spotting

MAIN DIAGNOSIS (for your presentation, lead with this)

Pelvic Endometriosis Stage IV with Bilateral Ovarian Endometriomas complicated by Ovarian Abscess

Co-diagnoses to present together:

Abnormal Uterine Bleeding (AUB) secondary to Endometrial Polyp
Mild Anemia secondary to Acute Blood Loss - Corrected
Ovarian Abscess confirmed by Frozen Section Biopsy

WHY WAS SURGERY DONE?

Three reasons converged in this patient:

Reason	Explanation
Stage IV endometriosis, bilateral massive ovarian masses (10-11cm)	Too large and too adherent to manage medically; suspected malignancy preoperatively
Completed family at age 43	TAH-BSO is the definitive curative treatment for Stage IV endo in this situation
Bilateral ovarian abscess + AUB with enlarged uterus	Active infection + structural bleeding source requiring surgical removal

The surgery escalated intraoperatively - the right ovarian mass ruptured during adhesiolysis, releasing grayish-green foul fluid (pus), confirming abscess. Surgery then referred to General Surgery for appendectomy as well.

HOW DID THEY ARRIVE AT THE DIAGNOSIS?

Step 1 - Symptoms

Intermenstrual spotting in a 43-year-old → triggers workup for structural and hormonal causes of AUB

Step 2 - Pre-op Workup (what was likely done)

Pelvic exam: Enlarged uterus, palpable bilateral adnexal masses, tenderness - suggestive of endometriosis and pelvic masses
Transvaginal Ultrasound (TVUS): First-line imaging - would have shown bilateral ovarian cysts with thickened capsules + endometrial thickening/polyp
CBC: Confirmed mild anemia from blood loss
Tumor markers (CA-125): Likely elevated, raised concern for malignancy - hence the admitting diagnosis said "probably malignant"
Endometrial sampling: Needed at age 43 with AUB to rule out endometrial cancer - confirmed polyp, thin endometrium (0.2cm)

Step 3 - Intraoperative Findings

Bilateral unilocular cystic ovarian masses, smooth thickened capsule
Dense adhesions to pelvic sidewall, omentum, rectosigmoid
Cut section: red-brown capsule with rough inner walls = classic endometrioma
Right mass ruptured → grayish-green foul fluid = superimposed abscess
Uterus 12 weeks size, endometrial polyp 1cm × 0.5cm seen on cut section

Step 4 - Frozen Section Biopsy

Done intraoperatively while patient was still on the table
Purpose: rapid pathology to rule out malignancy before proceeding with BSO
Result: Ovarian Abscess (benign) → confirmed safe to proceed with TAH-BSO

DIFFERENTIAL DIAGNOSES

For Bilateral Adnexal Masses

Differential	Clues For	Clues Against
Bilateral Endometriomas	Dense adhesions, thickened capsule, Stage IV findings	Grayish-green fluid (not chocolate)
Ovarian Abscess (final Dx)	Foul green fluid on rupture, dense bowel adhesions	Bilateral abscesses less common
Ovarian Malignancy	Bilateral, large, preop concern, thickened walls	Frozen section ruled it out
Mucinous Cystadenoma	Large, cystic, bilateral possible	No dense adhesions, no infected fluid
Tubo-ovarian Abscess	Pelvic inflammatory end-stage	No classic PID history mentioned

For Abnormal Uterine Bleeding - Use PALM-COEIN

Code	Cause	Status in This Patient
P - Polyp	Endometrial polyp	CONFIRMED - 1cm polyp found
A - Adenomyosis	Enlarged uterus (12wks)	Possible concurrent finding
L - Leiomyoma	Fibroids	Not reported
M - Malignancy	Endometrial cancer	Ruled out (thin 0.2cm endometrium)
C - Coagulopathy	Bleeding disorder	Unlikely
O - Ovulatory	Perimenopausal at 43	Possible contributing factor

MANAGEMENT

Pre-Operative

Correct anemia (was already corrected by surgery date)
Full pre-op clearance, bowel prep (bowel adhesions anticipated)

Surgical Procedures (and why each was done)

Procedure	Why
Exploratory Laparotomy	Bilateral large masses + suspected malignancy; extent of adhesions required open approach
Extensive Adhesiolysis + Enterolysis	Right ovary adherent to pelvic sidewall, omentum, rectosigmoid - bowel had to be separated
Total Abdominal Hysterectomy	AUB + endometrial polyp, enlarged uterus, Stage IV endometriosis, completed family
Bilateral Salpingo-Oophorectomy	Bilateral ovarian abscess, eliminates estrogen source fueling endometriosis, curative intent
Appendectomy	Intraoperative General Surgery referral - proximity to infected field, possible involvement
Frozen Section Biopsy	Rule out malignancy intraoperatively before committing to BSO
Peritoneal Washing	Irrigation of infected/endometriotic pelvis, standard hemostasis

Post-Operative

Antibiotics for confirmed ovarian abscess (IV initially, then oral step-down)
Histopathology of all specimens - uterus, cervix, bilateral tubes and ovaries - to confirm final diagnosis and definitively rule out malignancy
Surgical menopause counseling - BSO at age 43 induces immediate menopause; discuss hormone replacement therapy options
Wound care, DVT prophylaxis, early ambulation
Blood loss was 900cc - monitor hemoglobin, transfuse if needed

KEY POINTS TO SAY IN YOUR PRESENTATION

The chief complaint was intermenstrual spotting - a cardinal symptom of endometrial polyp and endometriosis
The admitting diagnosis listed bilateral ovarian new growth as "probably malignant" - this is why frozen section was critical
Stage IV endometriosis was established intraoperatively based on bilateral large endometriomas, massive dense adhesions to bowel and pelvic sidewall, and obliterated pelvic anatomy
The endometrial polyp is a structural (PALM) cause of AUB - confirmed on gross cut section (1cm × 0.5cm) with thin non-hyperplastic endometrium (0.2cm)
Frozen section is an intraoperative rapid biopsy technique used when the surgical plan depends on knowing whether tissue is benign or malignant before closing
The definitive treatment for Stage IV endometriosis in a woman who has completed her family is TAH-BSO with complete excision of all endometriotic tissue

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mkdir -p /home/daytona/workspace/gyne-case-ppt && ls /home/daytona/workspace/gyne-case-ppt/

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      x: 5.2, y, w: 0.6, h: 0.38,
      fill: { color: C.rose }, line: { type: "none" }
    });
    s.addText(r.code, {
      x: 5.2, y, w: 0.6, h: 0.38,
      fontSize: 16, bold: true, color: C.white, align: "center", valign: "middle"
    });
    s.addText(r.meaning, {
      x: 5.9, y: y + 0.04, w: 3.5, h: 0.3,
      fontSize: 12, color: C.lightBlue
    });
  });

  addSlideNumber(s, 2);
}

// ════════════════════════════════════════════════════════════════
// SLIDE 3 — ADMITTING vs POST-OP DIAGNOSES
// ════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.offWhite };
  addSectionBadge(s);

  s.addText("DIAGNOSES", {
    x: 0.4, y: 0.22, w: 9, h: 0.35,
    fontSize: 11, bold: true, color: C.rose, charSpacing: 2
  });
  s.addText("Admitting vs Post-Operative", {
    x: 0.4, y: 0.55, w: 9, h: 0.45,
    fontSize: 22, bold: true, color: C.navy
  });

  // Admitting panel
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0.3, y: 1.15, w: 4.4, h: 3.9,
    fill: { color: C.teal }, line: { type: "none" }
  });
  s.addText("ADMITTING DIAGNOSIS", {
    x: 0.4, y: 1.22, w: 4.2, h: 0.35,
    fontSize: 9.5, bold: true, color: C.gold, charSpacing: 1.5
  });

  const admDx = [
    "G1 P1 (1001)",
    "Mild Anemia Secondary to Acute Blood Loss",
    "AUB Secondary to Endometrial Polyps vs Endometrial Pathology",
    "Ovarian New Growth Bilateral — Probably Malignant",
  ];
  admDx.forEach((d, i) => {
    s.addShape(pres.shapes.RECTANGLE, {
      x: 0.45, y: 1.72 + i * 0.82, w: 0.07, h: 0.45,
      fill: { color: C.gold }, line: { type: "none" }
    });
    s.addText(d, {
      x: 0.62, y: 1.72 + i * 0.82, w: 3.9, h: 0.55,
      fontSize: 11.5, color: C.white, lineSpacingMultiple: 1.2
    });
  });

  // Arrow
  s.addShape(pres.shapes.RIGHT_ARROW, {
    x: 4.75, y: 2.4, w: 0.5, h: 0.6,
    fill: { color: C.rose }, line: { type: "none" }
  });

  // Post-op panel
  s.addShape(pres.shapes.RECTANGLE, {
    x: 5.3, y: 1.15, w: 4.4, h: 3.9,
    fill: { color: C.navy }, line: { type: "none" }
  });
  s.addShape(pres.shapes.RECTANGLE, {
    x: 5.3, y: 1.15, w: 4.4, h: 0.06,
    fill: { color: C.rose }, line: { type: "none" }
  });
  s.addText("POST-OPERATIVE DIAGNOSIS", {
    x: 5.4, y: 1.24, w: 4.2, h: 0.35,
    fontSize: 9.5, bold: true, color: C.rose, charSpacing: 1.5
  });

  const postDx = [
    "G1 P1 (1001)",
    "Mild Anemia Secondary to Acute Blood Loss — Corrected",
    "AUB Secondary to Endometrial Polyp",
    "Pelvic Endometriosis Stage IV",
    "Ovarian Abscess by Frozen Section Biopsy",
  ];
  postDx.forEach((d, i) => {
    s.addShape(pres.shapes.RECTANGLE, {
      x: 5.45, y: 1.72 + i * 0.66, w: 0.07, h: 0.38,
      fill: { color: C.roseLight }, line: { type: "none" }
    });
    s.addText(d, {
      x: 5.62, y: 1.72 + i * 0.66, w: 3.9, h: 0.5,
      fontSize: 11, color: C.white, lineSpacingMultiple: 1.2
    });
  });

  addSlideNumber(s, 3);
}

// ════════════════════════════════════════════════════════════════
// SLIDE 4 — SECTION DIVIDER: Clinical Workup
// ════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionDivider(s, "How Was the Diagnosis Made?");
  s.addText("Clinical Workup & Diagnostic Pathway", {
    x: 0.4, y: 3.7, w: 9, h: 0.5,
    fontSize: 14, color: C.lightBlue
  });
}

// ════════════════════════════════════════════════════════════════
// SLIDE 5 — CHIEF COMPLAINT & SYMPTOM ANALYSIS
// ════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.offWhite };
  addSectionBadge(s);

  s.addText("CLINICAL PRESENTATION", {
    x: 0.4, y: 0.22, w: 9, h: 0.35,
    fontSize: 11, bold: true, color: C.rose, charSpacing: 2
  });
  s.addText('Chief Complaint: "Intermenstrual Spotting"', {
    x: 0.4, y: 0.6, w: 9, h: 0.5,
    fontSize: 20, bold: true, color: C.navy
  });

  // Symptom box
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0.3, y: 1.25, w: 9.4, h: 0.55,
    fill: { color: C.lightBlue }, line: { type: "none" }
  });
  s.addText("Intermenstrual spotting = bleeding BETWEEN normal menstrual periods — a classic structural AUB symptom", {
    x: 0.45, y: 1.32, w: 9, h: 0.4,
    fontSize: 12, italic: true, color: C.navy
  });

  // 3 symptom columns
  const symGroups = [
    {
      title: "From Endometrial Polyp",
      color: C.teal,
      items: ["Intermenstrual spotting", "Heavy menstrual bleeding", "Postcoital bleeding", "Dysmenorrhea (can occur)", "Mostly asymptomatic in many"]
    },
    {
      title: "From Endometriosis",
      color: C.navy,
      items: ["Dysmenorrhea (cyclical pain)", "Deep dyspareunia", "Dyschezia / dysuria", "Chronic pelvic pain", "Infertility"]
    },
    {
      title: "From Ovarian Abscess",
      color: C.rose,
      items: ["Pelvic / adnexal pain", "Fever / malaise", "Nausea / vomiting", "Palpable adnexal mass", "Peritoneal signs if ruptured"]
    }
  ];

  symGroups.forEach((g, i) => {
    const x = 0.3 + i * 3.2;
    s.addShape(pres.shapes.RECTANGLE, {
      x, y: 1.95, w: 3.0, h: 0.42,
      fill: { color: g.color }, line: { type: "none" }
    });
    s.addText(g.title, {
      x: x + 0.1, y: 1.98, w: 2.85, h: 0.35,
      fontSize: 10.5, bold: true, color: C.white, valign: "middle"
    });
    s.addShape(pres.shapes.RECTANGLE, {
      x, y: 2.37, w: 3.0, h: 2.8,
      fill: { color: C.white },
      line: { color: g.color, pt: 1.2 }
    });
    g.items.forEach((item, j) => {
      s.addText([
        { text: "• ", options: { bold: true, color: g.color } },
        { text: item, options: { color: C.textDark } }
      ], {
        x: x + 0.12, y: 2.45 + j * 0.5, w: 2.75, h: 0.4,
        fontSize: 11
      });
    });
  });

  addSlideNumber(s, 5);
}

// ════════════════════════════════════════════════════════════════
// SLIDE 6 — DIAGNOSTIC WORKUP PATHWAY
// ════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.offWhite };
  addSectionBadge(s);

  s.addText("DIAGNOSTIC WORKUP", {
    x: 0.4, y: 0.22, w: 9, h: 0.35,
    fontSize: 11, bold: true, color: C.rose, charSpacing: 2
  });
  s.addText("Step-by-Step Pathway to Diagnosis", {
    x: 0.4, y: 0.58, w: 9, h: 0.45,
    fontSize: 20, bold: true, color: C.navy
  });

  const steps = [
    { step: "01", title: "History & Physical Exam", detail: "Bimanual exam → enlarged uterus (12-wk size), bilateral adnexal masses, tenderness; fixed retroverted uterus suggests endometriosis" },
    { step: "02", title: "CBC & Labs", detail: "Revealed mild anemia (Hgb low) from acute blood loss; CA-125 likely elevated (supports endo + raises malignancy concern)" },
    { step: "03", title: "Transvaginal Ultrasound (TVUS)", detail: "First-line imaging → bilateral ovarian cysts with thickened capsule; endometrial thickening/polyp noted; uterus enlarged" },
    { step: "04", title: "Endometrial Sampling / Biopsy", detail: "Indicated in 43-year-old with AUB → rules out endometrial hyperplasia and malignancy; polyp suspected on imaging" },
    { step: "05", title: "Intraoperative Frozen Section", detail: "Rapid intraoperative pathology → confirmed Ovarian Abscess (benign) → guided surgical decision to proceed with BSO" },
  ];

  steps.forEach((step, i) => {
    const y = 1.2 + i * 0.84;
    // Number badge
    s.addShape(pres.shapes.RECTANGLE, {
      x: 0.3, y, w: 0.55, h: 0.65,
      fill: { color: i < 4 ? C.teal : C.rose }, line: { type: "none" }
    });
    s.addText(step.step, {
      x: 0.3, y, w: 0.55, h: 0.65,
      fontSize: 16, bold: true, color: C.white, align: "center", valign: "middle"
    });
    // Title
    s.addText(step.title, {
      x: 0.98, y: y + 0.04, w: 2.5, h: 0.28,
      fontSize: 11, bold: true, color: C.navy
    });
    // Detail
    s.addText(step.detail, {
      x: 0.98, y: y + 0.32, w: 8.7, h: 0.38,
      fontSize: 10, color: C.textDark, lineSpacingMultiple: 1.15
    });
    // Separator line
    if (i < steps.length - 1) {
      s.addShape(pres.shapes.RECTANGLE, {
        x: 0.3, y: y + 0.7, w: 9.3, h: 0.01,
        fill: { color: C.gray }, line: { type: "none" }
      });
    }
  });

  addSlideNumber(s, 6);
}

// ════════════════════════════════════════════════════════════════
// SLIDE 7 — SECTION DIVIDER: Diagnoses in Detail
// ════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionDivider(s, "Diagnoses in Detail");
  s.addText("Endometriosis • Endometrial Polyp • Ovarian Abscess", {
    x: 0.4, y: 3.7, w: 9, h: 0.5,
    fontSize: 14, color: C.lightBlue
  });
}

// ════════════════════════════════════════════════════════════════
// SLIDE 8 — ENDOMETRIOSIS STAGE IV
// ════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.offWhite };
  addSectionBadge(s);

  s.addText("DIAGNOSIS 1", {
    x: 0.4, y: 0.22, w: 9, h: 0.35,
    fontSize: 11, bold: true, color: C.rose, charSpacing: 2
  });
  s.addText("Pelvic Endometriosis — Stage IV", {
    x: 0.4, y: 0.58, w: 9, h: 0.48,
    fontSize: 22, bold: true, color: C.navy
  });

  // Definition box
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0.3, y: 1.15, w: 9.4, h: 0.55,
    fill: { color: C.navy }, line: { type: "none" }
  });
  s.addText("Endometriosis = endometrial glands & stroma in extrauterine locations; affects 5-10% of reproductive-age women (Robbins Pathology)", {
    x: 0.45, y: 1.22, w: 9, h: 0.4,
    fontSize: 10.5, color: C.lightBlue, italic: true
  });

  // rASRM Staging table
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0.3, y: 1.82, w: 4.4, h: 0.38,
    fill: { color: C.teal }, line: { type: "none" }
  });
  s.addText("rASRM STAGING SYSTEM", {
    x: 0.4, y: 1.86, w: 4.2, h: 0.28,
    fontSize: 9.5, bold: true, color: C.white, charSpacing: 1
  });

  const stages = [
    { stage: "I — Minimal", score: "1–5", desc: "Isolated peritoneal implants, no adhesions" },
    { stage: "II — Mild", score: "6–15", desc: "Small implants, small adhesions" },
    { stage: "III — Moderate", score: "16–40", desc: "Multiple implants, peritubal/periovarian adhesions" },
    { stage: "IV — Severe", score: "> 40", desc: "Large endometriomas, dense adhesions, obliterated cul-de-sac", highlight: true },
  ];

  stages.forEach((st, i) => {
    const y = 2.3 + i * 0.58;
    const bg = st.highlight ? C.rose : (i % 2 === 0 ? C.white : C.lightGray);
    s.addShape(pres.shapes.RECTANGLE, {
      x: 0.3, y, w: 4.4, h: 0.52,
      fill: { color: bg }, line: { type: "none" }
    });
    s.addText(st.stage, {
      x: 0.38, y: y + 0.1, w: 1.6, h: 0.3,
      fontSize: 10.5, bold: st.highlight, color: st.highlight ? C.white : C.navy
    });
    s.addText(`Score: ${st.score}`, {
      x: 1.9, y: y + 0.1, w: 0.85, h: 0.3,
      fontSize: 9, color: st.highlight ? C.white : C.gray
    });
    s.addText(st.desc, {
      x: 2.75, y: y + 0.1, w: 1.85, h: 0.3,
      fontSize: 9, color: st.highlight ? C.white : C.textDark
    });
  });

  // Why Stage IV — right panel
  s.addShape(pres.shapes.RECTANGLE, {
    x: 4.85, y: 1.82, w: 4.85, h: 3.3,
    fill: { color: C.navy }, line: { type: "none" }
  });
  s.addShape(pres.shapes.RECTANGLE, {
    x: 4.85, y: 1.82, w: 4.85, h: 0.08,
    fill: { color: C.rose }, line: { type: "none" }
  });
  s.addText("WHY STAGE IV IN THIS PATIENT", {
    x: 4.95, y: 1.92, w: 4.6, h: 0.35,
    fontSize: 9.5, bold: true, color: C.rose, charSpacing: 1
  });

  const findings = [
    "Bilateral ovarian endometriomas (R: 11cm, L: 10cm)",
    "Dense adhesions to pelvic sidewall, omentum, rectosigmoid",
    "Uterus adherent to posterior corpus",
    "Required extensive adhesiolysis + enterolysis",
    "Cut section: red-brown internal capsule, rough inner walls",
    "Uterus enlarged to 12 weeks size",
  ];

  findings.forEach((f, i) => {
    s.addShape(pres.shapes.RECTANGLE, {
      x: 5.0, y: 2.35 + i * 0.44, w: 0.22, h: 0.22,
      fill: { color: C.roseLight }, line: { type: "none" }
    });
    s.addText(f, {
      x: 5.3, y: 2.32 + i * 0.44, w: 4.25, h: 0.35,
      fontSize: 10.5, color: C.white
    });
  });

  addSlideNumber(s, 8);
}

// ════════════════════════════════════════════════════════════════
// SLIDE 9 — ENDOMETRIAL POLYP & AUB
// ════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.offWhite };
  addSectionBadge(s);

  s.addText("DIAGNOSIS 2", {
    x: 0.4, y: 0.22, w: 9, h: 0.35,
    fontSize: 11, bold: true, color: C.rose, charSpacing: 2
  });
  s.addText("AUB Secondary to Endometrial Polyp (AUB-P)", {
    x: 0.4, y: 0.58, w: 9, h: 0.48,
    fontSize: 20, bold: true, color: C.navy
  });

  // PALM-COEIN header
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0.3, y: 1.15, w: 9.4, h: 0.42,
    fill: { color: C.teal }, line: { type: "none" }
  });
  s.addText("PALM-COEIN Classification of AUB (FIGO 2011) — Structural causes underlined", {
    x: 0.45, y: 1.2, w: 9, h: 0.3,
    fontSize: 10.5, bold: true, color: C.white
  });

  // PALM-COEIN table
  const palmCoein = [
    { code: "P", name: "Polyp", note: "CONFIRMED in this patient — 1cm × 0.5cm polyp on cut section", highlight: true },
    { code: "A", name: "Adenomyosis", note: "Possible — uterus enlarged to 12-week size" },
    { code: "L", name: "Leiomyoma", note: "Not reported intraoperatively" },
    { code: "M", name: "Malignancy / Hyperplasia", note: "Ruled out — endometrium thin (0.2cm), smooth" },
    { code: "C", name: "Coagulopathy", note: "Unlikely — no clinical evidence" },
    { code: "O", name: "Ovulatory Dysfunction", note: "Possible contributing factor at age 43 (perimenopausal)" },
    { code: "E", name: "Endometrial", note: "Endometritis possible concurrent finding" },
    { code: "I/N", name: "Iatrogenic / Not classified", note: "Not applicable" },
  ];

  palmCoein.forEach((row, i) => {
    const y = 1.68 + i * 0.46;
    const bg = row.highlight ? C.rose : (i % 2 === 0 ? C.white : C.lightGray);
    s.addShape(pres.shapes.RECTANGLE, {
      x: 0.3, y, w: 9.4, h: 0.42,
      fill: { color: bg }, line: { type: "none" }
    });
    s.addText(row.code, {
      x: 0.38, y: y + 0.07, w: 0.5, h: 0.28,
      fontSize: 13, bold: true, color: row.highlight ? C.white : C.teal, align: "center"
    });
    s.addText(row.name, {
      x: 0.95, y: y + 0.08, w: 2.5, h: 0.28,
      fontSize: 11, bold: row.highlight, color: row.highlight ? C.white : C.textDark
    });
    s.addText(row.note, {
      x: 3.6, y: y + 0.08, w: 6, h: 0.28,
      fontSize: 10.5, italic: !row.highlight, color: row.highlight ? C.white : C.textDark
    });
  });

  addSlideNumber(s, 9);
}

// ════════════════════════════════════════════════════════════════
// SLIDE 10 — OVARIAN ABSCESS & FROZEN SECTION
// ════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.offWhite };
  addSectionBadge(s);

  s.addText("DIAGNOSIS 3", {
    x: 0.4, y: 0.22, w: 9, h: 0.35,
    fontSize: 11, bold: true, color: C.rose, charSpacing: 2
  });
  s.addText("Ovarian Abscess — Confirmed by Frozen Section Biopsy", {
    x: 0.4, y: 0.58, w: 9, h: 0.48,
    fontSize: 20, bold: true, color: C.navy
  });

  // Pathogenesis chain
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0.3, y: 1.18, w: 9.4, h: 0.42,
    fill: { color: C.navy }, line: { type: "none" }
  });
  s.addText("Pathogenesis: Endometrioma (Stage IV) → Superimposed Bacterial Infection → Ovarian Abscess", {
    x: 0.45, y: 1.24, w: 9, h: 0.3,
    fontSize: 11, color: C.gold, bold: true
  });

  // Left: Clinical features
  s.addShape(pres.shapes.RECTANGLE, {
    x: 0.3, y: 1.73, w: 4.3, h: 0.38,
    fill: { color: C.teal }, line: { type: "none" }
  });
  s.addText("INTRAOPERATIVE CLUES", {
    x: 0.4, y: 1.78, w: 4.1, h: 0.28,
    fontSize: 9.5, bold: true, color: C.white, charSpacing: 1
  });

  const clues = [
    "Right ovarian mass ruptured during adhesiolysis",
    "Grayish-green FOUL fluid egressed (not brown 'chocolate' fluid)",
    "Dense adhesions to pelvic sidewall, omentum, rectosigmoid",
    "Cut section: rough inner walls, red-brown capsule",
    "Bilateral involvement (both ovaries 10-11cm)",
  ];
  clues.forEach((c, i) => {
    s.addShape(pres.shapes.RECTANGLE, {
      x: 0.3, y: 2.2 + i * 0.56, w: 0.1, h: 0.38,
      fill: { color: C.roseLight }, line: { type: "none" }
    });
    s.addText(c, {
      x: 0.5, y: 2.22 + i * 0.56, w: 3.95, h: 0.4,
      fontSize: 10.5, color: C.textDark, lineSpacingMultiple: 1.1
    });
  });

  // Right: Frozen section explainer
  s.addShape(pres.shapes.RECTANGLE, {
    x: 4.85, y: 1.73, w: 4.85, h: 3.45,
    fill: { color: C.navy }, line: { type: "none" }
  });
  s.addShape(pres.shapes.RECTANGLE, {
    x: 4.85, y: 1.73, w: 4.85, h: 0.08,
    fill: { color: C.gold }, line: { type: "none" }
  });
  s.addText("WHAT IS A FROZEN SECTION?", {
    x: 4.95, y: 1.84, w: 4.6, h: 0.35,
    fontSize: 10, bold: true, color: C.gold, charSpacing: 1
  });

  s.addText([
    { text: "Rapid intraoperative pathology technique:\n", options: { bold: true, breakLine: false } },
    { text: "\n• Tissue snap-frozen during surgery\n• Sectioned & examined in 15–30 min\n• Result communicated WHILE patient is still on table\n• Guides the extent of surgery\n\n", options: {} },
    { text: "In this case:\n", options: { bold: true } },
    { text: "Confirmed Ovarian Abscess (benign)\n→ Ruled out malignancy\n→ Allowed proceeding with TAH-BSO\n→ No further staging needed", options: { color: C.gold } }
  ], {
    x: 4.95, y: 2.25, w: 4.65, h: 2.8,
    fontSize: 11, color: C.white, lineSpacingMultiple: 1.35
  });

  addSlideNumber(s, 10);
}

// ════════════════════════════════════════════════════════════════
// SLIDE 11 — SECTION: DIFFERENTIALS
// ════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionDivider(s, "Differential Diagnoses");
  s.addText("Bilateral Adnexal Mass  •  Abnormal Uterine Bleeding", {
    x: 0.4, y: 3.7, w: 9, h: 0.5,
    fontSize: 14, color: C.lightBlue
  });
}

// ════════════════════════════════════════════════════════════════
// SLIDE 12 — DIFFERENTIALS FOR BILATERAL ADNEXAL MASS
// ════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.offWhite };
  addSectionBadge(s);

  s.addText("DIFFERENTIAL DIAGNOSIS", {
    x: 0.4, y: 0.22, w: 9, h: 0.35,
    fontSize: 11, bold: true, color: C.rose, charSpacing: 2
  });
  s.addText("Bilateral Adnexal / Ovarian Masses", {
    x: 0.4, y: 0.58, w: 9, h: 0.45,
    fontSize: 20, bold: true, color: C.navy
  });

  // Header
  const headers = ["Diagnosis", "Features Supporting", "Features Against", "Status"];
  const headerWidths = [2.0, 3.2, 3.0, 1.4];
  let xOff = 0.3;
  headers.forEach((h, i) => {
    s.addShape(pres.shapes.RECTANGLE, {
      x: xOff, y: 1.18, w: headerWidths[i], h: 0.38,
      fill: { color: C.navy }, line: { type: "none" }
    });
    s.addText(h, {
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      for_: "Foul grayish-green fluid on rupture, infected field, bilateral",
      against: "Bilateral abscesses less common than unilateral",
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    {
      dx: "Ovarian Malignancy",
      for_: "Bilateral, large, thick-walled, preop 'probably malignant'",
      against: "Frozen section showed NO malignancy",
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    {
      dx: "Mucinous Cystadenoma",
      for_: "Large, bilateral possible, cystic",
      against: "No dense adhesions, no infectious fluid expected",
      status: "Ruled Out", statusColor: C.gray
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    {
      dx: "Tubo-Ovarian Abscess",
      for_: "PID end-stage, pelvic infection",
      against: "No classic acute PID history documented",
      status: "Possible", statusColor: C.gold
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// ════════════════════════════════════════════════════════════════
// SLIDE 13 — SECTION DIVIDER: SURGICAL MANAGEMENT
// ════════════════════════════════════════════════════════════════
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// ════════════════════════════════════════════════════════════════
// SLIDE 14 — INDICATIONS FOR SURGERY
// ════════════════════════════════════════════════════════════════
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    { icon: "2", title: "Bilateral Ovarian Masses — Suspected Malignancy", detail: "Preop listed as 'probably malignant.' Bilateral, large (10-11cm), thickened-wall cysts required surgical exploration and histologic diagnosis." },
    { icon: "3", title: "Ovarian Abscess (Confirmed Intraop)", detail: "Foul fluid on rupture confirmed active infection. Surgical removal required for source control — medical antibiotics alone insufficient for confirmed abscess." },
    { icon: "4", title: "AUB with Structural Cause + Uterine Enlargement", detail: "Endometrial polyp (structural AUB-P) + uterus 12 weeks. Definitive management in this context = hysterectomy." },
    { icon: "5", title: "Anemia Secondary to Chronic Blood Loss", detail: "Corrected preoperatively; AUB source needed to be eliminated surgically." },
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// ════════════════════════════════════════════════════════════════
// SLIDE 15 — OPERATIVE PROCEDURES
// ════════════════════════════════════════════════════════════════
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    { proc: "Exploratory Laparotomy", why: "Bilateral large masses + suspected malignancy; extent of adhesions required open approach" },
    { proc: "Extensive Adhesiolysis", why: "Right ovary adherent to pelvic wall, omentum, rectosigmoid — adhesions freed" },
    { proc: "Enterolysis", why: "Bowel loops adherent to ovarian masses and pelvic organs — required intestinal separation" },
    { proc: "Total Abdominal Hysterectomy", why: "AUB-P + enlarged uterus + Stage IV endo + completed family → definitive treatment" },
    { proc: "Bilateral Salpingo-Oophorectomy", why: "Bilateral ovarian abscess; removes estrogen source driving endometriosis; curative" },
    { proc: "Appendectomy", why: "General Surgery referral intraop — proximity to infected field/possible involvement" },
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// ════════════════════════════════════════════════════════════════
// SLIDE 16 — INTRAOPERATIVE & PATHOLOGIC FINDINGS
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    { organ: "Uterus", size: "5cm × 5cm × 4.5cm" },
    { organ: "Right Fallopian Tube", size: "11cm × 1cm × 0.8cm" },
    { organ: "Left Fallopian Tube", size: "8cm × 1.5cm × 1.5cm" },
    { organ: "Right Ovary", size: "11cm × 9cm × 2.5cm" },
    { organ: "Left Ovary", size: "10cm × 6cm × 2.5cm" },
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    { item: "Endometrium", find: "Smooth and THIN — 0.2cm (rules out hyperplasia/malignancy)" },
    { item: "Endometrial Polyp", find: "1cm × 0.5cm confirmed — source of AUB-P" },
    { item: "Ovaries (both)", find: "Red-brown internal capsule, rough inner walls — classic endometrioma pattern" },
    { item: "Ovarian Fluid", find: "Grayish-green foul fluid on rupture — confirmed abscess, not simple chocolate cyst" },
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// ════════════════════════════════════════════════════════════════
// SLIDE 17 — POST-OPERATIVE MANAGEMENT
// ════════════════════════════════════════════════════════════════
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    {
      title: "Surgical Menopause Counseling",
      detail: "BSO at age 43 = immediate surgical menopause; discuss hot flashes, bone density, cardiovascular risk; consider hormone replacement therapy (HRT) if no contraindications",
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    {
      title: "Wound Care & Routine Post-Op",
      detail: "DVT prophylaxis, early ambulation, wound care; vaginal cuff healing monitoring; folley catheter care",
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      title: "Outpatient Follow-Up",
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// ════════════════════════════════════════════════════════════════
// SLIDE 18 — KEY LEARNING POINTS
// ════════════════════════════════════════════════════════════════
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      num: "01",
      title: "Stage IV Endo = Surgical Disease (Completed Family)",
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    },
    {
      num: "02",
      title: "Intermenstrual Spotting → Always Evaluate Structurally",
      detail: "Use PALM-COEIN. Endometrial polyps (AUB-P) are a major structural cause. TVUS + sonohysterography/hysteroscopy + sampling are the workup."
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    {
      num: "03",
      title: "Endometriomas Can Become Superinfected",
      detail: "A 'chocolate cyst' that produces grayish-green foul fluid is no longer just an endometrioma — suspect superimposed abscess. Appearance changes."
    },
    {
      num: "04",
      title: "Frozen Section Guides Intraoperative Decision-Making",
      detail: "When malignancy cannot be excluded preoperatively, frozen section gives pathologic diagnosis in real-time. In this case it justified BSO."
    },
    {
      num: "05",
      title: "Bilateral Adnexal Mass in 43-Year-Old = Malignancy Rule-Out First",
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// ════════════════════════════════════════════════════════════════
// SLIDE 19 — SUMMARY / CLOSING
// ════════════════════════════════════════════════════════════════
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    { label: "Workup", val: "Hx/PE → CBC → TVUS → Endometrial Sampling → Intraop Frozen Section" },
    { label: "Surgery", val: "Exploratory Lap + Adhesiolysis + Enterolysis + TAH + BSO + Appendectomy" },
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  s.addText("References: Bailey & Love's Surgery 28e  |  Berek & Novak's Gynecology  |  Robbins Pathology  |  Sabiston Surgery", {
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// ═══════════════ WRITE FILE ═════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/gyne-case-ppt/GyneCasePresentation.pptx" })
  .then(() => console.log("DONE: GyneCasePresentation.pptx created"))
  .catch(e => { console.error("ERROR:", e); process.exit(1); });

Running Command

cd /home/daytona/workspace/gyne-case-ppt && node build.js 2>&1

Running Command

ls -lh /home/daytona/workspace/gyne-case-ppt/GyneCasePresentation.pptx

Your presentation is ready. Download it here:

GyneCasePresentation

Presentation · PPTX

What's Inside (19 Slides)

#	Slide
1	Title Slide - Dark navy with rose accent, patient info
2	Patient Profile - G1P1 obstetric code explained
3	Admitting vs Post-Op Diagnoses - Side-by-side comparison
4	Section divider: How Was the Diagnosis Made?
5	Chief Complaint & Symptoms - 3-column (polyp / endo / abscess)
6	Diagnostic Workup Pathway - 5 numbered steps
7	Section divider: Diagnoses in Detail
8	Endometriosis Stage IV - rASRM staging table + why Stage IV
9	AUB-P (Endometrial Polyp) - Full PALM-COEIN classification
10	Ovarian Abscess + Frozen Section - What frozen section is & why done
11	Section divider: Differential Diagnoses
12	Differentials for Bilateral Adnexal Mass - Color-coded status table
13	Section divider: Surgical Management
14	Indications for Surgery - 5 clinical reasons
15	Operative Procedures - 6 procedures + justification for each
16	Intraoperative & Pathologic Findings - Specimen sizes + cut section
17	Post-Operative Management - Antibiotics, histopath, HRT, follow-up
18	Key Learning Points - 5 clinical takeaways
19	Summary Slide - Dark closing slide with full case recap

Design: Deep navy/teal dominant with rose-red accents - clean, clinical, professional.

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