#!/usr/bin/env python3
"""Generate Pathology Spotters Answer PDF using reportlab."""

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

OUTPUT = "/home/daytona/workspace/pathology-spotters/Pathology_Spotters_Answers.pdf"

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    rightMargin=2*cm,
    leftMargin=2*cm,
    topMargin=2*cm,
    bottomMargin=2*cm,
)

styles = getSampleStyleSheet()

# Custom styles
title_style = ParagraphStyle(
    'CustomTitle',
    parent=styles['Title'],
    fontSize=20,
    textColor=colors.HexColor('#1a237e'),
    spaceAfter=6,
    alignment=TA_CENTER,
)
subtitle_style = ParagraphStyle(
    'Subtitle',
    parent=styles['Normal'],
    fontSize=11,
    textColor=colors.HexColor('#37474f'),
    spaceAfter=16,
    alignment=TA_CENTER,
)
section_style = ParagraphStyle(
    'Section',
    parent=styles['Heading1'],
    fontSize=14,
    textColor=colors.HexColor('#b71c1c'),
    spaceBefore=14,
    spaceAfter=4,
    borderPad=4,
)
spotter_title_style = ParagraphStyle(
    'SpotterTitle',
    parent=styles['Heading2'],
    fontSize=12,
    textColor=colors.HexColor('#0d47a1'),
    spaceBefore=10,
    spaceAfter=2,
    backColor=colors.HexColor('#e3f2fd'),
    borderPad=6,
    leftIndent=0,
)
scenario_style = ParagraphStyle(
    'Scenario',
    parent=styles['Normal'],
    fontSize=10,
    textColor=colors.HexColor('#424242'),
    spaceBefore=2,
    spaceAfter=4,
    leftIndent=10,
    fontName='Helvetica-Oblique',
)
q_style = ParagraphStyle(
    'Question',
    parent=styles['Normal'],
    fontSize=10,
    textColor=colors.HexColor('#1b5e20'),
    spaceBefore=3,
    spaceAfter=1,
    leftIndent=10,
    fontName='Helvetica-Bold',
)
ans_style = ParagraphStyle(
    'Answer',
    parent=styles['Normal'],
    fontSize=10,
    textColor=colors.HexColor('#212121'),
    spaceBefore=1,
    spaceAfter=4,
    leftIndent=22,
    fontName='Helvetica',
)
bullet_style = ParagraphStyle(
    'Bullet',
    parent=styles['Normal'],
    fontSize=10,
    textColor=colors.HexColor('#212121'),
    spaceBefore=0,
    spaceAfter=2,
    leftIndent=30,
    fontName='Helvetica',
)
note_style = ParagraphStyle(
    'Note',
    parent=styles['Normal'],
    fontSize=9,
    textColor=colors.HexColor('#6d4c41'),
    spaceBefore=2,
    spaceAfter=4,
    leftIndent=22,
    fontName='Helvetica-Oblique',
)

def HR():
    return HRFlowable(width="100%", thickness=1, color=colors.HexColor('#bbdefb'), spaceAfter=4)

def section_hr():
    return HRFlowable(width="100%", thickness=2, color=colors.HexColor('#b71c1c'), spaceAfter=6)

def spotter(number, name, scenario, qas, notes=None):
    """Build a spotter block. qas = list of (question, answer_lines)"""
    items = []
    items.append(Paragraph(f"Spotter {number}: {name}", spotter_title_style))
    if scenario:
        items.append(Paragraph(f"<i>{scenario}</i>", scenario_style))
    for q, ans_lines in qas:
        items.append(Paragraph(q, q_style))
        if isinstance(ans_lines, list):
            for line in ans_lines:
                if line.startswith("•"):
                    items.append(Paragraph(line, bullet_style))
                else:
                    items.append(Paragraph(line, ans_style))
        else:
            items.append(Paragraph(ans_lines, ans_style))
    if notes:
        items.append(Paragraph(f"<i>Note: {notes}</i>", note_style))
    items.append(HR())
    return KeepTogether(items)


story = []

# ─── COVER ────────────────────────────────────────────────────────────────────
story.append(Spacer(1, 2*cm))
story.append(Paragraph("PATHOLOGY SPOTTERS", title_style))
story.append(Paragraph("Complete Answer Key", title_style))
story.append(Spacer(1, 0.4*cm))
story.append(Paragraph("Gross & Microscopy Spotters — Second Year MBBS", subtitle_style))
story.append(Paragraph("Prepared for Exam Preparation | June 2026", subtitle_style))
story.append(Spacer(1, 0.5*cm))
story.append(HRFlowable(width="100%", thickness=3, color=colors.HexColor('#1a237e')))
story.append(Spacer(1, 0.3*cm))

# Table of contents hint
toc_data = [
    ["Section", "Spotters"],
    ["A — Gross Pathology (Standard)", "1–16"],
    ["B — Microscopy Spotters", "17–18"],  
    ["C — Second Year Gross Pathology", "19–28"],
]
toc_table = Table(toc_data, colWidths=[12*cm, 4*cm])
toc_table.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#1a237e')),
    ('TEXTCOLOR', (0,0), (-1,0), colors.white),
    ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'),
    ('FONTSIZE', (0,0), (-1,-1), 10),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#e8eaf6'), colors.white]),
    ('GRID', (0,0), (-1,-1), 0.5, colors.HexColor('#9fa8da')),
    ('ALIGN', (0,0), (-1,-1), 'LEFT'),
    ('LEFTPADDING', (0,0), (-1,-1), 8),
    ('TOPPADDING', (0,0), (-1,-1), 6),
    ('BOTTOMPADDING', (0,0), (-1,-1), 6),
]))
story.append(toc_table)
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION A — GROSS PATHOLOGY (Standard / 2nd Gross PDF)
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph("SECTION A: GROSS PATHOLOGY SPOTTERS", section_style))
story.append(section_hr())

# 1. Appendicitis
story.append(spotter(
    1, "Acute Appendicitis",
    "A 9-year-old boy, emergency admission with right lower quadrant pain, fever, vomiting × 1 day. WBC = 17,000/mm³.",
    [
        ("Q1. What is your probable diagnosis?",
         ["Diagnosis: Acute Appendicitis.",
          "• The appendix is swollen, congested, with fibrinopurulent exudate on its serosal surface.",
          "• Clinical triad: RLQ pain + fever + leukocytosis confirms the diagnosis."]),
        ("Q2. What is the predominant inflammatory cell in this disease?",
         ["Neutrophils (PMNs) — hallmark of acute inflammation.",
          "• They infiltrate all layers of the appendicular wall (mucosa, submucosa, muscularis, serosa).",
          "• High WBC (17,000) with neutrophilia supports this."]),
    ]
))

# 2. Lipoma
story.append(spotter(
    2, "Lipoma",
    "A 30-year-old male with a large slow-growing lump over the shoulder × 5 years, not increasing in size.",
    [
        ("Q1. Identify the specimen.",
         ["Diagnosis: Lipoma.",
          "• Gross: Soft, encapsulated, yellowish mass composed of mature adipose tissue.",
          "• Benign tumor of adipocytes; most common soft tissue tumor.",
          "• Slow growth, no malignant transformation in typical lipoma."]),
    ],
    notes="Distinguish from Liposarcoma: Liposarcoma shows lipoblasts with scalloped nuclei, irregular borders, firm consistency."
))

# 3. Squamous Cell Carcinoma (oral / leg)
story.append(spotter(
    3, "Squamous Cell Carcinoma",
    "A 60-year-old female with non-healing ulcer in the oral cavity. Also: ulceroproliferative growth in leg of a 45-year-old man × 2 years.",
    [
        ("Q1. Identify the specimen and write your diagnosis.",
         ["Diagnosis: Squamous Cell Carcinoma (SCC).",
          "• Gross: Ulceroproliferative lesion with raised everted edges, indurated base, necrotic center.",
          "• Arises from stratified squamous epithelium or areas of squamous metaplasia."]),
        ("Q2. Mention five sites where you may find similar lesions.",
         ["1. Oral cavity (lips, tongue, floor of mouth)",
          "2. Larynx and pharynx",
          "3. Esophagus",
          "4. Skin (especially sun-exposed areas)",
          "5. Cervix uteri",
          "• Also: lung (central type), urinary bladder (after metaplasia)"]),
    ]
))

# 4. Gangrene / Diabetic foot (infarct of lower limb)
story.append(spotter(
    4, "Gangrene / Arterial Occlusion (Infarct)",
    "A patient with sudden severe pain in lower calf; absent dorsalis pedis pulse.",
    [
        ("Q1. Identify the specimen.",
         ["Diagnosis: Dry Gangrene (Ischemic Infarct of lower limb) due to arterial occlusion.",
          "• Gross: Blackened, dry, mummified tissue of the foot/leg.",
          "• Caused by atherosclerosis with thrombus formation, blocking arterial supply."]),
        ("Q2. Write identifying points.",
         ["1. Dry, shriveled, mummified appearance",
          "2. Clear line of demarcation between viable and dead tissue",
          "3. Dark brown to black discoloration (hemoglobin degradation products)",
          "4. No putrefaction (coagulative necrosis dominates)",
          "5. Loss of tissue architecture microscopically"]),
        ("Q3. What are the types of infarcts?",
         ["Based on color:",
          "• Red (hemorrhagic) infarct: Occurs in loose tissues (lung, intestine) or with dual blood supply. Tissue soaked in blood.",
          "• White (pale/anemic) infarct: Occurs in solid organs with end-arterial supply (heart, kidney, spleen).",
          "Based on infection:",
          "• Septic infarct: Infected, e.g., by septic emboli.",
          "• Bland infarct: Non-infected."]),
    ]
))

# 5. Nutmeg Liver
story.append(spotter(
    5, "Nutmeg Liver (Chronic Passive Venous Congestion)",
    "Patient had right-sided cardiac failure and enlarged tender liver.",
    [
        ("Q1. What is your diagnosis?",
         ["Diagnosis: Chronic Passive Venous Congestion of Liver (Congestive Hepatomegaly).",
          "• Right heart failure → ↑ central venous pressure → hepatic vein congestion → centrilobular congestion."]),
        ("Q2. What is the other name for this?",
         ["Nutmeg Liver.",
          "• Gross appearance: Cut surface shows alternating red (congested centrilobular zones) and yellow (fatty peripheral zones) areas — resembling the cut surface of a nutmeg.",
          "• Chronic cases → cardiac cirrhosis (cardiac sclerosis)."]),
    ]
))

# 6. Pulmonary Tuberculosis / Ghon complex
story.append(spotter(
    6, "Pulmonary Tuberculosis (Ghon's Complex)",
    "A 30-year-old male with weight loss, respiratory distress, hemoptysis and low-grade fever.",
    [
        ("Q1. Identify the specimen.",
         ["Diagnosis: Pulmonary Tuberculosis — Primary complex (Ghon's Complex).",
          "• Gross: Grayish-white caseous foci in the lung parenchyma with hilar lymphadenopathy."]),
        ("Q2. What is Ghon's Complex?",
         ["Ghon's Complex = Ghon's focus + Draining lymphangitis + Hilar/mediastinal lymphadenopathy.",
          "• Ghon's focus: Initial subpleural caseating granuloma in the mid-zone of the lung (usually lower lobe upper segment or upper lobe lower segment).",
          "• Caused by Mycobacterium tuberculosis.",
          "• Histology: Caseating granuloma with Langhans giant cells, epithelioid cells, lymphocytes.",
          "• In primary TB: the Ghon complex calcifies and heals (Ranke complex)."]),
    ]
))

# 7. Carcinoma Lung
story.append(spotter(
    7, "Carcinoma of the Lung",
    "A 60-year-old male, chronic smoker × 20 years, breathlessness, hemoptysis, chest pain, weight loss, anorexia.",
    [
        ("Q1. Write two causes of this tumor.",
         ["1. Cigarette smoking (most important — responsible for ~85% of lung cancers). Polycyclic aromatic hydrocarbons, nitrosamines cause DNA mutations (K-RAS, TP53).",
          "2. Occupational/environmental carcinogens: Asbestos exposure, radon gas, industrial chemicals (arsenic, chromium, nickel), air pollution.",
          "• Other causes: Radiation, pre-existing lung scars (scar carcinoma), genetic predisposition."]),
    ]
))

# 8. Atherosclerosis (Aorta)
story.append(spotter(
    8, "Atherosclerosis of Aorta",
    "Post mortem of a 50-year-old obese man; lesion found on the aorta.",
    [
        ("Q1. Identify the lesion.",
         ["Diagnosis: Atherosclerosis of Aorta.",
          "• Gross: Yellow-white plaques (atheromas) on the intima of the aorta. Advanced plaques may show calcification, ulceration, or thrombosis."]),
        ("Q2. Name two complications of this lesion.",
         ["1. Aortic Aneurysm: Weakening of the aortic wall by plaques leads to aneurysmal dilation (especially abdominal aorta).",
          "2. Thrombosis/Embolism: Plaque rupture triggers thrombus formation → arterial occlusion → Myocardial Infarction, Stroke, or peripheral ischemia.",
          "• Other complications: Ischemic heart disease, renal artery stenosis, mesenteric ischemia."]),
    ]
))

# 9. Colorectal Carcinoma (right-sided / exophytic)
story.append(spotter(
    9, "Colorectal Carcinoma (Exophytic / Right-Sided)",
    "A 74-year-old man with rectal bleeding. Specimen of colon shown.",
    [
        ("Q1. Write your diagnosis with two identification points.",
         ["Diagnosis: Colorectal Adenocarcinoma.",
          "• Identification point 1: Fungating/polypoid (exophytic) mass projecting into the lumen with ulceration and necrosis.",
          "• Identification point 2: Irregular, cauliflower-like growth arising from the colonic mucosa."]),
        ("Q2. List two gross morphological types.",
         ["1. Polypoid/Exophytic (fungating) type — more common in the right (ascending) colon; projects into lumen; presents with occult bleeding/anemia.",
          "2. Ulcerative/Napkin ring (annular) type — more common in the left (descending/sigmoid) colon; encircles the bowel wall → obstruction."]),
    ]
))

# 10. Colorectal Carcinoma (Napkin Ring)
story.append(spotter(
    10, "Colorectal Carcinoma — Napkin Ring Type",
    "A 72-year-old man with large bowel obstruction.",
    [
        ("Q1. What is your diagnosis? Write two causes.",
         ["Diagnosis: Colorectal Carcinoma — Annular (Napkin Ring) type.",
          "• Cause 1: Colorectal adenocarcinoma encircling the bowel circumferentially (most common cause of large bowel obstruction in adults > 50 years).",
          "• Cause 2: Diverticular disease / Sigmoid volvulus (other causes of large bowel obstruction)."]),
        ("Q2. What is Napkin Ring growth?",
         ["A pattern of colorectal carcinoma where the tumor encircles the entire circumference of the bowel lumen like a napkin ring.",
          "• Results in progressive luminal narrowing → obstruction.",
          "• Typical of left-sided (sigmoid/descending) colon carcinoma.",
          "• Microscopically: moderately differentiated adenocarcinoma invading through the bowel wall."]),
    ]
))

# 11. Intussusception
story.append(spotter(
    11, "Intussusception",
    "A 24-year-old man with acute pain abdomen. Specimen of intestine given.",
    [
        ("Q1. Write your diagnosis and mention two identification points.",
         ["Diagnosis: Intussusception.",
          "• Identification point 1: Telescoping of one segment of bowel into another — the intussusceptum (inner segment) is visible within the intussuscipiens (outer segment).",
          "• Identification point 2: Congested, edematous, bluish-purple discoloration of the involved segment due to vascular compromise.",
          "• Note: In adults, usually caused by a lead point (polyp, tumor); in children often idiopathic (ileocolic junction)."]),
    ]
))

# 12. Leiomyoma Uterus
story.append(spotter(
    12, "Leiomyoma (Fibroid) of Uterus",
    "A 40-year-old female with menorrhagia × 3 years. Hysterectomy specimen.",
    [
        ("Q1. What is your diagnosis?",
         ["Diagnosis: Leiomyoma (Fibroid) of the Uterus.",
          "• Gross: Well-circumscribed, firm, rubbery, whorled white-grey nodular masses within the uterine wall.",
          "• Most common benign tumor of the female genital tract.",
          "• Estrogen-dependent; regresses after menopause.",
          "• Types by location: Intramural (most common), Submucosal (causes menorrhagia), Subserosal.",
          "• Microscopy: Interlacing bundles of smooth muscle cells with cigar-shaped nuclei."]),
    ]
))

# 13. Malignant Melanoma
story.append(spotter(
    13, "Malignant Melanoma",
    "A 56-year-old female noticed increased itching in a pre-existing mole.",
    [
        ("Q1. What is the diagnosis?",
         ["Diagnosis: Malignant Melanoma.",
          "• Malignant neoplasm of melanocytes; most aggressive skin cancer.",
          "• Warning signs (ABCDE): Asymmetry, Border irregularity, Color variation (black, brown, red, white), Diameter > 6 mm, Evolution/change."]),
        ("Q2. Write two important identification features.",
         ["1. Irregular, asymmetric pigmented lesion with variegated color (shades of brown, black, red, blue, white) and irregular borders — gross.",
          "2. Microscopically: Atypical melanocytes with large nuclei, prominent nucleoli, melanin pigment, and invasion of dermis (Breslow thickness determines prognosis)."]),
    ]
))

# 14. Secondary (Metastatic) Carcinoma Liver
story.append(spotter(
    14, "Secondary (Metastatic) Carcinoma Liver",
    "A 60-year-old female with breast lump, confirmed malignancy on FNAC, died after 3 months chemotherapy. Post-mortem liver specimen shown.",
    [
        ("Q1. Identify the specimen.",
         ["Diagnosis: Metastatic (Secondary) Carcinoma of the Liver.",
          "• Gross: Multiple, discrete, rounded nodules of varying sizes scattered throughout both lobes of the liver; nodules may have central umbilication ('umbilicated metastases').",
          "• Liver is the most common site of metastasis (receives portal + systemic blood supply).",
          "• Primary sites: Breast, colon, lung, stomach, pancreas, melanoma."]),
    ]
))

# 15. Dermoid Cyst / Teratoma (Ovary)
story.append(spotter(
    15, "Mature Cystic Teratoma (Dermoid Cyst) of Ovary",
    "A young female with left ovarian mass.",
    [
        ("Q1. What is your diagnosis?",
         ["Diagnosis: Mature Cystic Teratoma (Dermoid Cyst) of the Ovary.",
          "• Most common ovarian germ cell tumor.",
          "• Contains elements from all three germ layers: skin, hair, teeth, sebaceous material, bone."]),
        ("Q2. Give two identification points.",
         ["1. Cystic mass filled with thick sebaceous/greasy material, hair, and sometimes teeth or calcified areas — gross appearance.",
          "2. Microscopically: Lined by keratinizing squamous epithelium with skin adnexa (hair follicles, sebaceous glands) plus other germ layer derivatives."]),
    ]
))

# 16. Osteosarcoma
story.append(spotter(
    16, "Osteosarcoma",
    "A 14-year-old girl with painful, progressively increasing mass in the right knee.",
    [
        ("Q1. What is your diagnosis? Write two identification points.",
         ["Diagnosis: Osteosarcoma (Osteogenic Sarcoma).",
          "• Most common primary malignant bone tumor in adolescents.",
          "• Identification point 1: Gross — destructive metaphyseal mass with cortical destruction, periosteal elevation forming a 'sunburst pattern' radiologically; gritty/hard cut surface due to osteoid production.",
          "• Identification point 2: Microscopic — pleomorphic osteoblastic cells directly producing osteoid/tumor bone (key diagnostic feature)."]),
        ("Q2. What is Codman's Triangle?",
         ["Codman's Triangle is a radiological sign in osteosarcoma.",
          "• When the expanding tumor lifts the periosteum off the cortex, new reactive bone is deposited at the angle between the elevated periosteum and the cortex.",
          "• On X-ray: appears as a triangular shadow at the edge of the lesion.",
          "• Not specific to osteosarcoma — also seen in Ewing's sarcoma, osteomyelitis."]),
    ]
))

# 17. Diabetic Foot (Gangrene)
story.append(spotter(
    17, "Diabetic Foot (Dry/Wet Gangrene)",
    "A 65-year-old diabetic male with pain and discoloration of foot.",
    [
        ("Q1. Identify the lesion.",
         ["Diagnosis: Diabetic Foot Gangrene.",
          "• Caused by: (1) Peripheral arterial disease (atherosclerosis) causing ischemia, (2) Peripheral neuropathy causing pressure sores, (3) Infection.",
          "• Gross: Blackened, necrotic toes/foot with possible moist areas if infected (wet gangrene)."]),
        ("Q2. Name two complications.",
         ["1. Spreading infection/septicemia — particularly with wet gangrene, gas-forming organisms (Clostridium); risk of overwhelming sepsis.",
          "2. Necessity for amputation — limb loss due to uncontrolled necrosis and infection."]),
    ]
))

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION B — MICROSCOPY (HPE) SPOTTERS
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph("SECTION B: MICROSCOPY (HPE) SPOTTERS", section_style))
story.append(section_hr())

# PDF1 slides — microscopy
micro_spotters = [
    (18, "Lipoma (Microscopy)", None, [
        ("Q. Identify / Describe the microscopic features.",
         ["• Lobules of mature, univacuolated adipocytes (lipocytes) separated by thin fibrovascular septa.",
          "• Cells are uniform in size with peripheral, compressed nuclei.",
          "• No nuclear atypia, no lipoblasts (distinguishes from liposarcoma).",
          "• Encapsulated by a thin fibrous capsule."]),
    ]),
    (19, "Liposarcoma (Microscopy)", None, [
        ("Q. Identify / Describe the microscopic features.",
         ["• Key cell: LIPOBLAST — multivacuolated cell with scalloped (indented) nucleus.",
          "• Well-differentiated type: lipocyte-like cells + scattered lipoblasts.",
          "• Myxoid type: Myxoid stroma, plexiform capillary network + lipoblasts (most common subtype).",
          "• Pleomorphic type: Bizarre giant cells, marked pleomorphism.",
          "• Malignant soft tissue tumor; retroperitoneum and thigh most common sites."]),
    ]),
    (20, "Gallstones / Cholecystitis (Microscopy)", None, [
        ("Q. Identify the specimen.",
         ["• Gallbladder wall showing chronic cholecystitis: mucosal atrophy, fibrosis, chronic inflammatory infiltrate.",
          "• Rokitansky-Aschoff sinuses: outpouchings of mucosa into the muscular wall.",
          "• Stones: Cholesterol stones (pure, yellow, faceted), Mixed stones (most common — yellowish-brown), Pigment stones (black/brown — calcium bilirubinate)."]),
    ]),
    (21, "Colorectal Adenocarcinoma (Microscopy)", None, [
        ("Q. Identify / Describe.",
         ["• Malignant glandular structures (tubular or acinar pattern) invading through the bowel wall.",
          "• Cells: Columnar with hyperchromatic nuclei, loss of polarity, abnormal mitoses.",
          "• 'Dirty necrosis' — intraluminal necrotic debris in glands (characteristic of colorectal carcinoma).",
          "• Grading: Well-differentiated (>95% gland formation), moderately differentiated (50–95%), poorly differentiated (<50%)."]),
    ]),
    (22, "Diffuse Gastric Carcinoma / Signet Ring Cell (Microscopy)", None, [
        ("Q. Identify the specimen.",
         ["Diagnosis: Diffuse Gastric Carcinoma (Signet Ring Cell Carcinoma).",
          "• Cells: Large mucin-filled cytoplasm pushing the nucleus to the periphery → 'Signet ring' appearance.",
          "• No gland formation; infiltrates diffusely through gastric wall (linitis plastica — 'leather bottle stomach').",
          "• Associated with CDH1 (E-cadherin) mutation, H. pylori."]),
    ]),
    (23, "Juvenile / Hyperplastic Polyp (Microscopy)", None, [
        ("Q. Identify the specimen.",
         ["• Hamartomatous polyp with dilated, mucin-filled (cystically dilated) glands surrounded by abundant inflamed lamina propria.",
          "• No dysplasia in juvenile polyp (benign).",
          "• Common in children; rectosigmoid; presents with rectal bleeding.",
          "• Hyperplastic polyp: Serrated epithelial infoldings with saw-tooth pattern, no dysplasia, no malignant potential."]),
    ]),
    (24, "Squamous Cell Carcinoma (Microscopy)", None, [
        ("Q. Identify the specimen.",
         ["Diagnosis: Squamous Cell Carcinoma.",
          "• Nests and sheets of malignant squamous cells invading stroma.",
          "• Key features: Intercellular bridges (desmosomes), Keratin pearls (concentric whorls of keratinizing cells — in well-differentiated SCC), Individual cell keratinization.",
          "• Nuclear pleomorphism, hyperchromasia, abnormal mitoses."]),
    ]),
    (25, "Napkin Ring Colorectal Carcinoma (Gross-Histo)", None, [
        ("Q. Identify.",
         ["• Annular colorectal carcinoma encircling bowel lumen.",
          "• Microscopy: Moderately differentiated adenocarcinoma, glands with dirty necrosis, invading through muscularis propria.",
          "• Left-sided colon; presents with obstruction."]),
    ]),
    (26, "Tubercular Lymphadenitis (Microscopy)", None, [
        ("Q. Identify the specimen. What is the characteristic cell?",
         ["Diagnosis: Tubercular Lymphadenitis.",
          "• Histology: Caseating epithelioid cell granuloma with Langhans giant cells.",
          "• Langhans Giant Cell: Horseshoe (U-shaped) or peripheral arrangement of nuclei around a central pale cytoplasm. Formed by fusion of epithelioid macrophages. Pathognomonic of tuberculosis/granulomatous inflammation.",
          "• Caseous necrosis: Amorphous, eosinophilic, cheese-like central necrosis within the granuloma.",
          "• ZN stain: May show acid-fast bacilli (red against blue background)."]),
    ]),
    (27, "Pleomorphic Adenoma (Mixed Parotid Tumor)", None, [
        ("Q. Identify the specimen.",
         ["Diagnosis: Pleomorphic Adenoma (Benign Mixed Tumor) of the Parotid Gland.",
          "• Most common salivary gland tumor.",
          "• Gross: Firm, encapsulated, lobulated parotid mass.",
          "• Microscopy: Mixture of epithelial cells (forming ducts/acini) + mesenchymal/myxoid/chondroid stroma — hence 'mixed' tumor.",
          "• Benign but can recur if incompletely excised; rare malignant transformation → carcinoma ex pleomorphic adenoma."]),
    ]),
    (28, "Alcoholic Liver Disease (Microscopy)", None, [
        ("Q. Identify the specimen.",
         ["Diagnosis: Alcoholic Liver Disease (steatohepatitis/cirrhosis).",
          "• Features: Macrovesicular steatosis (large fat vacuoles displacing nucleus), Mallory-Denk bodies (pink cytoplasmic inclusions of intermediate filaments — pathognomonic of alcoholic hepatitis), Centrilobular necrosis, Neutrophilic infiltration.",
          "• Fibrosis pattern: Perivenular/pericellular (chicken wire) fibrosis → progresses to micronodular cirrhosis."]),
    ]),
    (29, "Lobar Pneumonia — Grey Hepatization (Microscopy)", None, [
        ("Q. Identify the specimen.",
         ["Diagnosis: Lobar Pneumonia — Stage of Grey Hepatization.",
          "• Grey hepatization: Day 3–8 of lobar pneumonia.",
          "• Gross: Lung firm, airless, gray, liver-like consistency.",
          "• Microscopy: Alveoli filled with fibrin strands, degenerate neutrophils, and RBCs (lysed — hence grey rather than red).",
          "• Stages of lobar pneumonia: Congestion → Red Hepatization → Grey Hepatization → Resolution.",
          "• Organism: Streptococcus pneumoniae (most common)."]),
    ]),
    (30, "Teratoma (Microscopy)", None, [
        ("Q. Identify the specimen.",
         ["Diagnosis: Mature Cystic Teratoma (Dermoid Cyst).",
          "• Contains well-differentiated tissues from all 3 germ layers:",
          "  - Ectoderm: Skin, hair follicles, sebaceous glands, neural tissue",
          "  - Mesoderm: Cartilage, muscle, bone",
          "  - Endoderm: Bronchial/intestinal epithelium",
          "• Most common ovarian germ cell tumor (>95% benign).",
          "• Malignant transformation in <2% (usually to SCC)."]),
    ]),
    (31, "Hepatocellular Carcinoma (Microscopy)", None, [
        ("Q. Identify the specimen.",
         ["Diagnosis: Hepatocellular Carcinoma (HCC).",
          "• Gross: Large, soft, greenish-yellow (bile-stained) mass with areas of necrosis and hemorrhage.",
          "• Microscopy: Malignant hepatocytes arranged in trabeculae/sheets separated by sinusoid-like vascular spaces, large nuclei with prominent nucleoli, bile production.",
          "• Risk factors: Hepatitis B/C, Liver cirrhosis, Aflatoxin B1, Alcohol.",
          "• Tumor marker: AFP (Alpha-fetoprotein) elevated."]),
    ]),
    (32, "Squamous Carcinoma Cervix (Microscopy)", None, [
        ("Q. Identify the specimen.",
         ["Diagnosis: Squamous Cell Carcinoma of the Cervix.",
          "• Arises from squamocolumnar junction (transformation zone).",
          "• HPV types 16 & 18 are the major causative agents (E6 inactivates p53; E7 inactivates Rb).",
          "• Microscopy: Invasive nests of malignant squamous cells with keratin pearls, intercellular bridges, invasion of stroma.",
          "• Preceded by CIN (Cervical Intraepithelial Neoplasia) → detected by Pap smear."]),
    ]),
    (33, "Meningioma (Microscopy)", None, [
        ("Q. Identify the specimen.",
         ["Diagnosis: Meningioma.",
          "• Benign tumor of arachnoid cap cells.",
          "• Gross: Well-encapsulated, lobulated, firm dural mass compressing brain (extra-axial).",
          "• Microscopy: Whorls of spindle-shaped meningothelial cells; PSAMMOMA BODIES — concentric laminated calcifications (pathognomonic).",
          "• Most common intracranial meningioma types: Meningothelial, Fibrous, Transitional (mixed)."]),
    ]),
    (34, "Appendicitis (Microscopy)", None, [
        ("Q. Identify the specimen.",
         ["Diagnosis: Acute Appendicitis.",
          "• Microscopy: Transmural neutrophilic infiltration of the appendicular wall (mucosa to serosa).",
          "• Key diagnostic criterion: Neutrophilic infiltration of the muscularis propria.",
          "• Luminal exudate, mucosal ulceration, fibrinopurulent serositis.",
          "• Complicated by: Perforation → peritonitis, abscess, portal pyemia."]),
    ]),
]

for s in micro_spotters:
    story.append(spotter(*s))

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION C — SECOND YEAR GROSS SPOTTERS
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph("SECTION C: SECOND YEAR GROSS PATHOLOGY SPOTTERS", section_style))
story.append(section_hr())

second_year = [
    (35, "Choriocarcinoma",
     "A young female with per-vaginal bleeding since childbirth (6 months back).",
     [
         ("Q1. Diagnosis? What biochemical test would you like to do?",
          ["Diagnosis: Choriocarcinoma (Gestational Trophoblastic Malignancy).",
           "• Biochemical test: Serum β-hCG (beta-Human Chorionic Gonadotropin) — markedly elevated; used for diagnosis AND monitoring treatment response.",
           "• Gross: Hemorrhagic, necrotic, dark-red friable uterine mass.",
           "• Follows: Normal pregnancy, hydatidiform mole, abortion, ectopic pregnancy."]),
         ("Q2. What are the sites for metastasis?",
          ["1. Lungs (most common — 'cannonball' metastases on CXR)",
           "2. Vagina",
           "3. Brain",
           "4. Liver",
           "5. Kidneys",
           "• Highly sensitive to chemotherapy (methotrexate); excellent prognosis even with metastases."]),
     ]),
    (36, "Retinoblastoma",
     "Child with leukocoria (white pupillary reflex).",
     [
         ("Q1. Identify the specimen.",
          ["Diagnosis: Retinoblastoma.",
           "• Most common intraocular malignancy in children (< 5 years).",
           "• Caused by mutation of RB1 (tumor suppressor gene) on chromosome 13q14.",
           "• Gross: White-cream colored mass in retina, may show calcification.",
           "• Microscopy: Homer-Wright rosettes and Flexner-Wintersteiner rosettes (photoreceptor differentiation).",
           "• Leukocoria = 'cat's eye reflex' = white papillary glow."]),
     ]),
    (37, "Fibroadenoma of Breast",
     "Young female with a breast lump.",
     [
         ("Q1. Identify the specimen.",
          ["Diagnosis: Fibroadenoma of the Breast.",
           "• Most common benign breast tumor in women under 35 years.",
           "• Gross: Well-circumscribed, firm, rubbery, mobile, encapsulated mass; white-gray on cut section with slit-like spaces.",
           "• Microscopy: Two components — fibrous stroma (myxoid) + proliferating ducts/acini (benign epithelium).",
           "• Types: Intracanalicular (stroma compresses ducts) and Pericanalicular (stroma surrounds open ducts).",
           "• Estrogen-sensitive; grows in reproductive age, regresses after menopause."]),
     ]),
    (38, "Hydatidiform Mole",
     "Young female, pregnant, uterine bleeding, uterus larger than dates.",
     [
         ("Q1. Identify the specimen.",
          ["Diagnosis: Hydatidiform Mole (Complete).",
           "• Gross: Uterus filled with grape-like clusters of swollen, translucent vesicles ('bunch of grapes') — edematous chorionic villi.",
           "• Biochemistry: Very high β-hCG.",
           "• Complete mole: 46XX (androgenetic), no fetal tissue, all villi hydropic.",
           "• Partial mole: Triploid (69XXY), may have fetal parts.",
           "• Risk: 2% → choriocarcinoma (complete mole >> partial mole)."]),
         ("Q2. Microscopic features.",
          ["• Hydropic (edematous) chorionic villi with central cistern formation.",
           "• Trophoblastic proliferation (both cyto- and syncytiotrophoblast).",
           "• No fetal blood vessels in villi (complete mole)."]),
     ]),
    (39, "Teratoma (Ovary)",
     "Young female with ovarian mass.",
     [
         ("Q1. Identify the specimen.",
          ["Diagnosis: Mature Cystic Teratoma (Dermoid Cyst) of Ovary.",
           "• Contains ectodermal (skin, hair, teeth), mesodermal, and endodermal derivatives.",
           "• Most common ovarian GCT; >95% benign.",
           "• Gross: Cyst filled with sebaceous material, hair; teeth may be visible."]),
     ]),
    (40, "Carcinoma Cervix",
     "Middle-aged female with vaginal bleeding, cervical growth.",
     [
         ("Q1. Identify the specimen.",
          ["Diagnosis: Carcinoma Cervix — Squamous Cell Carcinoma.",
           "• Gross: Exophytic/cauliflower-like or ulcerative growth at the cervix; may extend to vaginal fornices.",
           "• Hemorrhagic foci, irregular growth.",
           "• HPV 16/18 — causative.",
           "• Spreads via: Direct extension (bladder, rectum), Lymphatics (inguinal, iliac nodes), Hematogenous (late — lung, liver, bone)."]),
         ("Q2. Identification points.",
          ["1. Ulceroproliferative/exophytic mass at cervical os with irregular, bleeding surface",
           "2. Extension into vaginal fornices or parametrium in advanced cases",
           "3. Histologically: Invasive squamous nests, keratin pearls, stromal invasion"]),
     ]),
    (41, "Seminoma",
     "Young male with painless testicular swelling.",
     [
         ("Q1. Identify the specimen.",
          ["Diagnosis: Seminoma.",
           "• Most common testicular germ cell tumor (40–50%).",
           "• Age: 20–40 years; associated with cryptorchidism.",
           "• Gross: Homogeneous, cream/gray, bulging cut surface; lobulated; no hemorrhage/necrosis (unlike NSGCT).",
           "• Tumor marker: LDH elevated; PLAP (placental alkaline phosphatase) positive; β-hCG normal or mildly elevated.",
           "• Microscopy: Large cells with clear glycogen-rich cytoplasm, central nucleus with prominent nucleolus; lymphocytic stroma; fibrous septa.",
           "• Highly radiosensitive; excellent prognosis."]),
         ("Q2. Related tumors.",
          ["• Yolk Sac Tumor (Endodermal Sinus Tumor): Most common in infants/children; AFP elevated; Schiller-Duval bodies (glomeruloid structures).",
           "• Leydig Cell Tumor: Reinke crystals; androgens → precocious puberty in boys."]),
     ]),
    (42, "BPH (Benign Prostatic Hyperplasia)",
     "Elderly male with urinary hesitancy, nocturia, weak stream.",
     [
         ("Q1. Identify the specimen.",
          ["Diagnosis: Benign Prostatic Hyperplasia (BPH).",
           "• Gross: Enlarged prostate with multiple rubbery nodules; cut section shows nodular hyperplasia of periurethral (transition) zone.",
           "• Microscopy: Nodular hyperplasia of both glandular epithelium and fibromuscular stroma; glands lined by two cell layers (basal + luminal).",
           "• Pathogenesis: DHT (dihydrotestosterone) mediated — 5α-reductase converts testosterone → DHT.",
           "• Complications: Bladder outlet obstruction, hydronephrosis, UTI, bladder stones, acute urinary retention."]),
     ]),
    (43, "Amoebic Liver Abscess",
     "Young male, traveler from endemic area, RUQ pain, fever.",
     [
         ("Q1. Identify the specimen.",
          ["Diagnosis: Amoebic Liver Abscess.",
           "• Caused by Entamoeba histolytica; hematogenous spread via portal vein from large intestine.",
           "• Gross: Single large abscess (usually right lobe); cavity filled with thick, reddish-brown, odorless 'anchovy sauce' / 'chocolate sauce' pus (liquefied hepatocytes + trophozoites).",
           "• Microscopy: Amorphous necrotic debris; viable trophozoites at the periphery of the abscess wall.",
           "• Complications: Rupture into pleural cavity, pericardium, peritoneum."]),
     ]),
    (44, "Alcoholic Liver Cirrhosis",
     "Chronic alcoholic male with jaundice, ascites, hepatomegaly.",
     [
         ("Q1. Identify the specimen.",
          ["Diagnosis: Alcoholic Liver Cirrhosis.",
           "• Micronodular (Laennec's) cirrhosis: All nodules < 3 mm, uniform size, caused by alcohol.",
           "• Macronodular cirrhosis: Nodules of varying sizes (> 3 mm to several cm), caused by viral hepatitis (HBV/HCV).",
           "• Gross: Shrunken, firm liver with diffuse surface nodularity.",
           "• Microscopy: Regenerating hepatocyte nodules surrounded by fibrous septa; loss of normal lobular architecture.",
           "• Complications: Portal hypertension, esophageal varices, hepatic encephalopathy, HCC (especially macronodular)."]),
     ]),
    (45, "Secondary (Metastatic) Carcinoma Liver",
     "Known primary malignancy (breast/colon/lung) with liver deposits.",
     [
         ("Q1. Identify the specimen.",
          ["Diagnosis: Secondary (Metastatic) Carcinoma of the Liver.",
           "• Gross: Multiple, white-gray nodules throughout liver, often with central umbilication (due to central necrosis).",
           "• Much more common than primary HCC.",
           "• Routes of spread: Hematogenous (portal vein from GI tract, hepatic artery from other sites), Direct extension, Lymphatic.",
           "• Primary sites: Colorectal (most common via portal), Breast, Lung, Stomach, Pancreas."]),
     ]),
    (46, "Cholelithiasis (Gallstones)",
     "Middle-aged obese female with RUQ pain, colicky, post-fatty meal.",
     [
         ("Q1. Identify the specimen.",
          ["Diagnosis: Cholelithiasis (Gallstones).",
           "• Types of gallstones:",
           "  1. Cholesterol stones (10–15%): Pure, single, oval, yellow, faceted. Predisposed by 5 Fs: Fat, Female, Forty, Fertile, Fair.",
           "  2. Mixed stones (80%): Calcium carbonate + cholesterol + pigment. Multiple, faceted, yellowish-brown.",
           "  3. Pigment stones (10–15%): Black (sterile bile, hemolytic) or Brown (infected bile, infection with E. coli).",
           "• Complications: Cholecystitis, Biliary colic, Choledocholithiasis (CBD stones), Gallstone ileus, Mucocoele, Carcinoma gallbladder (porcelain gallbladder)."]),
     ]),
]

for s in second_year:
    story.append(spotter(*s))

# ─── BACK PAGE ─────────────────────────────────────────────────────────────────
story.append(PageBreak())
story.append(Spacer(1, 3*cm))
story.append(HRFlowable(width="100%", thickness=3, color=colors.HexColor('#1a237e')))
story.append(Spacer(1, 0.5*cm))
story.append(Paragraph("QUICK REFERENCE CARD", ParagraphStyle('QR', parent=styles['Heading1'],
    fontSize=16, textColor=colors.HexColor('#1a237e'), alignment=TA_CENTER)))
story.append(Spacer(1, 0.3*cm))

quick_data = [
    ["Spotter", "Diagnosis", "Key Feature / Buzzword"],
    ["Appendicitis", "Acute Appendicitis", "Transmural neutrophil infiltration; WBC 17,000"],
    ["Lipoma", "Lipoma", "Soft, encapsulated, mature adipocytes, NO lipoblasts"],
    ["Oral ulcer", "SCC", "Ulceroproliferative, keratin pearls, intercellular bridges"],
    ["Absent DP pulse", "Gangrene / Infarct", "Red vs. white infarct; dry vs. wet gangrene"],
    ["RHF + liver", "Nutmeg Liver", "Centrilobular congestion, alternating red-yellow zones"],
    ["Hemoptysis + LGF", "Pulmonary TB", "Ghon complex = focus + lymphangitis + node"],
    ["Smoker + mass", "Lung Carcinoma", "Smoking, asbestos = two top causes"],
    ["Aortic plaques", "Atherosclerosis", "Aneurysm + MI/stroke as complications"],
    ["Rectal bleeding", "CRC (exophytic)", "Polypoid, right colon, occult bleeding"],
    ["Bowel obstruction", "CRC (Napkin ring)", "Encircles lumen, left colon"],
    ["Acute abdomen", "Intussusception", "Telescoping, lead point in adults"],
    ["Menorrhagia", "Leiomyoma", "Whorled, estrogen-dependent, intramural > submucosal"],
    ["Changing mole", "Melanoma", "ABCDE, Breslow thickness for prognosis"],
    ["Liver nodules (breast)", "Metastatic Ca Liver", "Multiple umbilicated nodules"],
    ["Ovarian cyst", "Dermoid Cyst", "Skin + hair + teeth; all 3 germ layers"],
    ["Knee mass, teen", "Osteosarcoma", "Codman triangle, sunburst, osteoid production"],
    ["Diabetic foot", "Gangrene", "Atherosclerosis + neuropathy + infection"],
    ["Post-delivery bleeding", "Choriocarcinoma", "β-hCG elevated, cannonball mets to lung"],
    ["Leukocoria child", "Retinoblastoma", "RB1 gene, Flexner-Wintersteiner rosettes"],
    ["Young breast lump", "Fibroadenoma", "Mobile, firm, slit-like ducts, two cell layers"],
    ["Grape-like uterus", "Hydatidiform Mole", "Edematous villi, high β-hCG, cistern formation"],
    ["Cervical growth", "Ca Cervix (SCC)", "HPV 16/18, inguinal/iliac lymph nodes"],
    ["Painless testis swelling", "Seminoma", "Clear cells, lymphocytic stroma, radiosensitive"],
    ["Elderly urinary sx", "BPH", "Transition zone, DHT-mediated, nodular hyperplasia"],
    ["Anchovy pus liver", "Amoebic Abscess", "E. histolytica, right lobe, chocolate pus"],
    ["Alcoholic + cirrhosis", "Micronodular Cirrhosis", "Nodules <3mm, Mallory bodies, alcohol"],
    ["TB lymph node", "Tubercular Lymphadenitis", "Caseating granuloma, Langhans giant cell (horseshoe)"],
    ["Parotid lump", "Pleomorphic Adenoma", "Epithelium + chondromyxoid stroma, mixed"],
    ["Grey firm lung", "Lobar Pneumonia (Grey)", "Day 3–8, fibrin + degenerate PMNs, Strep. pneumoniae"],
    ["Gallstones", "Cholelithiasis", "5 Fs, cholesterol > mixed > pigment stones"],
]

qt = Table(quick_data, colWidths=[4.5*cm, 5*cm, 7.5*cm])
qt.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#1a237e')),
    ('TEXTCOLOR', (0,0), (-1,0), colors.white),
    ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'),
    ('FONTSIZE', (0,0), (-1,-1), 8),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#e8eaf6'), colors.white]),
    ('GRID', (0,0), (-1,-1), 0.3, colors.HexColor('#9fa8da')),
    ('ALIGN', (0,0), (-1,-1), 'LEFT'),
    ('LEFTPADDING', (0,0), (-1,-1), 4),
    ('TOPPADDING', (0,0), (-1,-1), 3),
    ('BOTTOMPADDING', (0,0), (-1,-1), 3),
    ('VALIGN', (0,0), (-1,-1), 'TOP'),
]))
story.append(qt)

story.append(Spacer(1, 1*cm))
story.append(Paragraph(
    "Best of luck for your Pathology exam! Remember: Identify → Gross features → Microscopy → Complications → Clinical correlation.",
    ParagraphStyle('Footer', parent=styles['Normal'], fontSize=9,
                   textColor=colors.HexColor('#37474f'), alignment=TA_CENTER)
))

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

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/pathology-spotters/generate_pdf.py'

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/pathology-spotters/generate_pdf.py'

Error: String 'story.append(HRFlowable(width="100%", thickness=3, color=colors.HexColor('#1a237e')))' appears multiple times. Use replace_all=True to replace all occurrences.

Successfully replaced 2 instance(s) of the string in '/home/daytona/workspace/pathology-spotters/generate_pdf.py'

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/pathology-spotters/generate_pdf.py'

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/pathology-spotters/generate_pdf.py'

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/pathology-spotters/generate_pdf.py'

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/pathology-spotters/generate_pdf.py'

#!/usr/bin/env python3
"""
Build Pathology OSPE Answer PDF
Each spotter = page image from PDF + full structured answers below/beside it.
"""

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

OUTPUT = "/home/daytona/workspace/pathology-spotters/Patho_OSPE_Complete_Answers.pdf"
IMG_DIR = "/home/daytona/workspace/pathology-spotters/pages"

W, H = A4  # 595 x 842 pts
MARGIN = 1.5 * cm

doc = SimpleDocTemplate(
    OUTPUT, pagesize=A4,
    rightMargin=MARGIN, leftMargin=MARGIN,
    topMargin=MARGIN, bottomMargin=MARGIN,
)

styles = getSampleStyleSheet()

# ── Styles ─────────────────────────────────────────────────────────────────
cover_title = ParagraphStyle('CT', parent=styles['Title'], fontSize=22,
    textColor=colors.black, spaceAfter=6, alignment=TA_CENTER)
cover_sub = ParagraphStyle('CS', parent=styles['Normal'], fontSize=11,
    textColor=colors.HexColor('#444444'), spaceAfter=4, alignment=TA_CENTER)

spotter_hdr = ParagraphStyle('SH', parent=styles['Normal'], fontSize=12,
    fontName='Helvetica-Bold', textColor=colors.white,
    backColor=colors.black, spaceBefore=0, spaceAfter=0,
    leftIndent=6, borderPad=5)

diag_style = ParagraphStyle('DX', parent=styles['Normal'], fontSize=11,
    fontName='Helvetica-Bold', textColor=colors.black,
    spaceBefore=4, spaceAfter=2, leftIndent=6)

q_style = ParagraphStyle('QS', parent=styles['Normal'], fontSize=10,
    fontName='Helvetica-Bold', textColor=colors.black,
    spaceBefore=4, spaceAfter=1, leftIndent=8)

a_style = ParagraphStyle('AS', parent=styles['Normal'], fontSize=10,
    fontName='Helvetica', textColor=colors.black,
    spaceBefore=0, spaceAfter=2, leftIndent=18)

bullet_style = ParagraphStyle('BL', parent=styles['Normal'], fontSize=10,
    fontName='Helvetica', textColor=colors.black,
    spaceBefore=0, spaceAfter=1, leftIndent=26)

note_style = ParagraphStyle('NT', parent=styles['Normal'], fontSize=9,
    fontName='Helvetica-Oblique', textColor=colors.HexColor('#555555'),
    spaceBefore=2, spaceAfter=2, leftIndent=18)

img_caption = ParagraphStyle('IC', parent=styles['Normal'], fontSize=8,
    fontName='Helvetica-Oblique', textColor=colors.HexColor('#555555'),
    spaceBefore=1, spaceAfter=4, alignment=TA_CENTER)

def HR(thick=0.5, col='#aaaaaa'):
    return HRFlowable(width="100%", thickness=thick, color=colors.HexColor(col), spaceAfter=3)

def page_img(pg_num, max_w=None, max_h=None, caption=None):
    """Return image element for a given page number."""
    path = os.path.join(IMG_DIR, f"pg-{pg_num:03d}.jpg")
    if not os.path.exists(path):
        return None
    mw = max_w or (W - 2*MARGIN)
    mh = max_h or 9*cm
    img = Image(path, width=mw, height=mh, kind='proportional')
    items = [img]
    if caption:
        items.append(Paragraph(caption, img_caption))
    return items

def spotter_block(num, title, img_pages, qa_list, note=None):
    """
    num       : spotter number
    title     : diagnosis / topic
    img_pages : list of page numbers whose images to embed
    qa_list   : list of (question_str, [answer_line, ...])
    note      : optional italic note
    """
    els = []
    # Header bar
    els.append(Spacer(1, 0.2*cm))
    els.append(Paragraph(f"  SPOTTER {num}  —  {title}", spotter_hdr))
    els.append(Spacer(1, 0.15*cm))

    # Images — embed each source page
    for pg in img_pages:
        imgs = page_img(pg, max_w=W - 2*MARGIN - 0.4*cm, max_h=8*cm,
                        caption=f"[Figure — Page {pg} of original OSPE PDF]")
        if imgs:
            for el in imgs:
                els.append(el)

    els.append(Spacer(1, 0.1*cm))
    # Diagnosis line
    els.append(Paragraph(f"Diagnosis: {title}", diag_style))
    els.append(HR(1.0, '#000000'))

    # Q&A
    for q, ans_lines in qa_list:
        els.append(Paragraph(q, q_style))
        for line in ans_lines:
            if line.startswith("•"):
                els.append(Paragraph(line, bullet_style))
            else:
                els.append(Paragraph(line, a_style))

    if note:
        els.append(Paragraph(f"Note: {note}", note_style))

    els.append(HR(0.5, '#aaaaaa'))
    els.append(Spacer(1, 0.1*cm))
    return KeepTogether(els)


# ═══════════════════════════════════════════════════════════════════════
# BUILD STORY
# ═══════════════════════════════════════════════════════════════════════
story = []

# ── COVER ───────────────────────────────────────────────────────────────
story.append(Spacer(1, 2.5*cm))
story.append(Paragraph("PATHOLOGY OSPE", cover_title))
story.append(Paragraph("Complete Spotter Answer Key with Figures", cover_title))
story.append(Spacer(1, 0.4*cm))
story.append(Paragraph("Every spotter from Patho OSPE Priti PDF", cover_sub))
story.append(Paragraph("Gross & Microscopy | Second Year MBBS | June 2026", cover_sub))
story.append(Spacer(1, 0.5*cm))
story.append(HR(2, '#000000'))
story.append(Spacer(1, 0.3*cm))

toc = [
    ["#", "Spotter / Diagnosis", "Type"],
    ["1","Acute Appendicitis (Gross)","Gross"],
    ["2","Acute Appendicitis (Micro)","Micro"],
    ["3","Lipoma (Gross)","Gross"],
    ["4","Oral SCC — Jaw (Gross)","Gross"],
    ["5","SCC of Skin (Gross)","Gross"],
    ["6","Arterial Thrombosis (Gross)","Gross"],
    ["7","Splenic Infarct (Gross)","Gross"],
    ["8","Nutmeg Liver / Chronic Venous Congestion","Gross"],
    ["9","Pulmonary Tuberculosis — Ghon Complex","Gross"],
    ["10","Bronchogenic Carcinoma (Lung Ca)","Gross"],
    ["11","Atherosclerosis of Aorta","Gross"],
    ["12","Colorectal Carcinoma — Right Colon","Gross"],
    ["13","Colorectal Carcinoma — Napkin Ring","Gross"],
    ["14","Intestinal Gangrene","Gross"],
    ["15","Leiomyoma (Fibroid) of Uterus","Gross"],
    ["16","Malignant Melanoma (Skin)","Gross"],
    ["17","Metastatic Carcinoma of Liver","Gross"],
    ["18","Mature Cystic Teratoma (Ovary)","Gross"],
    ["19","Osteosarcoma","Gross"],
    ["20","Diabetic Foot / Gangrene","Gross"],
    ["21","Giant Cell Tumor of Bone","Gross"],
    ["22","Chondrosarcoma","Gross"],
    ["23","Colloid Goiter (Thyroid)","Gross"],
    ["24","Metastatic Liver (detailed)","Gross"],
    ["25","Cholelithiasis / Cholecystitis","Gross"],
    ["26","Liver Cirrhosis","Gross"],
    ["27","Amoebic Liver Abscess","Gross"],
    ["28","Ulcerative Colitis","Gross"],
    ["29","Choriocarcinoma","Gross"],
    ["30","Meningioma — Psammoma Bodies","Micro"],
    ["31","Fatty Liver / Hepatic Steatosis","Micro"],
    ["32","Alcoholic Hepatitis","Micro"],
    ["33","Acute Appendicitis (Micro)","Micro"],
    ["34","Tubercular Lymphadenitis","Micro"],
    ["35","Lipoma (Micro)","Micro"],
    ["36","Oral SCC (Micro)","Micro"],
    ["37","Colorectal Adenocarcinoma (Micro)","Micro"],
    ["38","Arterial Thrombosis (Micro)","Micro"],
    ["39","Chronic Venous Congestion Liver (Micro)","Micro"],
    ["40","Actinomycosis","Micro"],
    ["41","Rhinosporidiosis","Micro"],
    ["42","Lobar Pneumonia — Grey Hepatization","Micro"],
    ["43","Atherosclerosis (Micro)","Micro"],
    ["44","Capillary Hemangioma","Micro"],
    ["45","Cavernous Hemangioma","Micro"],
    ["46","Pulmonary TB — Granuloma (Micro)","Micro"],
    ["47","Bronchogenic Ca — Paraneoplastic","Micro"],
    ["48","Juvenile Rectal Polyp","Micro"],
    ["49","Amyloid Kidney","Micro"],
    ["50","Granulation Tissue","Micro"],
    ["51","Ovarian Teratoma (Micro)","Micro"],
    ["52","Acute MI (Micro)","Micro"],
    ["53","Schwannoma","Micro"],
    ["54","Papillary Carcinoma Thyroid","Micro"],
    ["55","Follicular Carcinoma Thyroid","Micro"],
    ["56","Thyrotoxicosis (Thyroid Micro)","Micro"],
    ["57","Wilms Tumor / Nephroblastoma","Micro"],
    ["58","Chronic Cholecystitis","Micro"],
    ["59","Liver Cirrhosis (Micro)","Micro"],
    ["60","Colorectal Adenocarcinoma (Micro 2)","Micro"],
    ["61","Juvenile Polyp (Micro 2)","Micro"],
    ["62","Intestinal TB (Micro)","Micro"],
    ["63","Diffuse Gastric Ca / Signet Ring","Micro"],
    ["64","Intestinal-type Gastric Ca","Micro"],
    ["65","Pleomorphic Adenoma Parotid","Micro"],
    ["66","Oral SCC (Micro 2)","Micro"],
    ["67","Melanoma (Micro)","Micro"],
]
toc_t = Table(toc, colWidths=[1*cm, 12*cm, 3*cm])
toc_t.setStyle(TableStyle([
    ('BACKGROUND',(0,0),(-1,0),colors.black),
    ('TEXTCOLOR',(0,0),(-1,0),colors.white),
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story.append(toc_t)
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════
# SPOTTERS
# ═══════════════════════════════════════════════════════════════════════

# 1. Acute Appendicitis — Gross (Pages 1-2)
story.append(spotter_block(1, "Acute Appendicitis (Gross Specimen)",
    [1, 2],
    [("Clinical scenario:",
      ["9-year-old boy, RLQ pain, fever, vomiting × 1 day. WBC = 17,000/mm³."]),
     ("Q1. What is your probable diagnosis?",
      ["Diagnosis: Acute Appendicitis.",
       "• The appendix is swollen, congested, with fibrinopurulent exudate on serosa.",
       "• OSPE pattern: Appendix with meso-appendix, ~2.5 cm, dilated blood vessels, swollen."]),
     ("Q2. What is the predominant inflammatory cell?",
      ["Neutrophils (Polymorphonuclear leukocytes — PMNs).",
       "• They infiltrate all layers of the appendicular wall.",
       "• Elevated WBC (17,000/mm³) with neutrophilia clinically confirms this."]),
    ]
))

# 2. Lipoma — Gross (Page 3)
story.append(spotter_block(2, "Lipoma (Gross Specimen)",
    [3],
    [("Clinical scenario:",
      ["30-year-old male, large lump over shoulder × 5 years, not growing."]),
     ("Q1. Identify the specimen.",
      ["Diagnosis: Lipoma.",
       "• Gross: Pale yellowish mass, well-circumscribed, well-encapsulated.",
       "• Soft, compressible, lobulated mass of mature adipose tissue.",
       "• Most common benign soft tissue tumor."]),
     ("Q2. Name the malignant counterpart.",
      ["Liposarcoma.",
       "• Key distinguishing feature: Lipoblasts (multivacuolated cells with scalloped nuclei) present in liposarcoma.",
       "• Special stains: Oil Red-O (fat), S100 (neural crest origin, also positive in lipoma/liposarcoma)."]),
    ]
))

# 3. Oral SCC — Jaw Gross (Page 4)
story.append(spotter_block(3, "Squamous Cell Carcinoma — Oral Cavity (Gross)",
    [4],
    [("Clinical scenario:",
      ["60-year-old female, non-healing oral ulcer."]),
     ("Q1. Identify the specimen and write your diagnosis.",
      ["Specimen: Jaw specimen showing ulceroproliferative mass.",
       "Diagnosis: Oral Squamous Cell Carcinoma (SCC).",
       "• Gross features: Ulceroproliferative growth with raised everted edges, indurated base."]),
     ("Q2. Five sites where similar lesions occur:",
      ["1. Lateral border of tongue (most common intraoral site)",
       "2. Floor of mouth",
       "3. Lower lip",
       "4. Buccal mucosa",
       "5. Hard palate",
       "• Also: Esophagus, lungs, skin (sun-exposed), cervix uteri."]),
    ]
))

# 4. SCC Skin — Leg (Page 5)
story.append(spotter_block(4, "Squamous Cell Carcinoma — Skin / Leg (Gross)",
    [5],
    [("Clinical scenario:",
      ["45-year-old male, ulceroproliferative growth on leg × 2 years, growing, non-healing."]),
     ("Q1. What is your diagnosis?",
      ["Diagnosis: Squamous Cell Carcinoma (SCC) of skin.",
       "• Gross: Ulceroproliferative growth with non-healing base."]),
     ("Q2. Two identification points:",
      ["1. Ulceroproliferative growth with raised, everted, indurated edges.",
       "2. Non-healing, progressively enlarging ulcer despite medical treatment.",
       "• Marjolin's ulcer: SCC arising in a chronic scar/burn/ulcer."]),
    ]
))

# 5. Arterial Thrombosis (Page 7)
story.append(spotter_block(5, "Arterial Thrombosis — Lines of Zahn (Gross)",
    [7],
    [("Clinical scenario:",
      ["Patient with sudden severe lower calf pain; absent dorsalis pedis pulse."]),
     ("Q1. Identify the specimen.",
      ["Diagnosis: Thrombosis in an artery (Arterial thrombus).",
       "• Gross: Firm, dry, grayish-white thrombus occluding the artery lumen."]),
     ("Q2. What are Lines of Zahn?",
      ["Lines of Zahn = alternating light and dark laminations within a thrombus.",
       "• Light layers = platelets + fibrin (pale, eosinophilic)",
       "• Dark layers = red blood cells (erythrocytes)",
       "• Best seen in ARTERIAL thrombi (high flow).",
       "• Significance: Confirms the thrombus formed ANTE-MORTEM (in life), not post-mortem.",
       "• Absent in post-mortem 'chicken fat' clots."]),
    ]
))

# 6. Splenic Infarct (Page 8)
story.append(spotter_block(6, "Splenic Infarct (Gross Specimen)",
    [8],
    [("Q1. Identify the specimen.",
      ["Specimen: Spleen.",
       "Diagnosis: Splenic Infarct.",
       "• Gross: Pale, wedge-shaped area of necrosis at the periphery of the spleen with the apex pointing towards the hilum."]),
     ("Q2. Identifying points:",
      ["• Splenic sinusoids visible.",
       "• Wedge-shaped pale area (white infarct) corresponding to occlusion of end-artery."]),
     ("Q3. Types of Infarcts:",
      ["1. WHITE (Pale/Anemic) Infarct:",
       "   • Solid organs with end-arterial supply: Heart, Kidney, Spleen.",
       "   • Coagulative necrosis.",
       "2. RED (Hemorrhagic) Infarct:",
       "   • Loose tissues / dual blood supply / reperfusion: Lung, Intestine, Liver, Brain (with reperfusion).",
       "   • Blood re-enters necrotic zone.",
       "3. SEPTIC Infarct:",
       "   • Infected by bacteria → abscess formation.",
       "   • E.g., septic emboli from infective endocarditis."]),
    ]
))

# 7. Nutmeg Liver (Page 9)
story.append(spotter_block(7, "Nutmeg Liver — Chronic Venous Congestion (Gross)",
    [9],
    [("Clinical scenario:",
      ["Patient with right-sided cardiac failure and enlarged, tender liver."]),
     ("Q1. What is your diagnosis?",
      ["Diagnosis: Chronic Passive Venous Congestion of the Liver.",
       "• Right heart failure → ↑ central venous pressure → hepatic vein congestion → centrilobular congestion & necrosis."]),
     ("Q2. Other names:",
      ["• Nutmeg Liver (gross appearance resembles cut surface of a nutmeg).",
       "• Congestive Hepatomegaly.",
       "• Gross: Alternating dark-red (congested centrilobular zones) and yellow (fatty mid-zonal hepatocytes) areas.",
       "• Microscopy: Dilated central veins, centrilobular hepatocyte necrosis, periportal viable hepatocytes.",
       "• Chronic → Cardiac Cirrhosis (cardiac sclerosis)."]),
    ]
))

# 8. Pulmonary TB (Page 10)
story.append(spotter_block(8, "Pulmonary Tuberculosis — Ghon Complex (Gross)",
    [10],
    [("Clinical scenario:",
      ["30-year-old male, weight loss, respiratory distress, hemoptysis, low-grade fever."]),
     ("Q1. Identify the specimen.",
      ["Specimen: Lungs with grayish discolouration and granulomatous lesions.",
       "Diagnosis: Primary Pulmonary Tuberculosis (Ghon Complex)."]),
     ("Q2. What is Ghon's Complex?",
      ["Ghon's Complex = Ghon's Focus + Regional Lymphatics + Hilar Lymph Node involvement.",
       "• Ghon's Focus: Small (~1 cm) subpleural caseating granuloma in the lung,",
       "  usually at the lower part of upper lobe or upper part of lower lobe.",
       "• Caused by: Mycobacterium tuberculosis (acid-fast bacillus).",
       "• Histology of focus: Caseating epithelioid granuloma with Langhans giant cells.",
       "• Calcified Ghon complex = Ranke Complex (healed primary TB).",
       "• In miliary TB: hematogenous spread → multiple small granulomas throughout both lungs."]),
    ]
))

# 9. Bronchogenic Carcinoma (Page 11)
story.append(spotter_block(9, "Bronchogenic Carcinoma — Lung Cancer (Gross)",
    [11],
    [("Clinical scenario:",
      ["60-year-old male, chronic smoker × 20 years, breathlessness, hemoptysis, chest pain, weight loss."]),
     ("Q1. Identify the specimen.",
      ["Specimen: Lung with multiple nodules in center.",
       "Diagnosis: Bronchogenic Carcinoma.",
       "• Central tumors: SCC and Small Cell Carcinoma.",
       "• Peripheral tumors: Large Cell Ca and Adenocarcinoma."]),
     ("Q2. Two causes of this tumor:",
      ["1. Cigarette smoking — most important; responsible for ~85% of lung cancers.",
       "   (Polycyclic aromatic hydrocarbons, nitrosamines cause TP53, K-RAS mutations.)",
       "2. Occupational/environmental: Asbestos, radon gas, arsenic, chromium, nickel, air pollution."]),
     ("Q3. Two paraneoplastic syndromes:",
      ["1. Hypercalcemia — due to PTHrP secretion → Squamous Cell Carcinoma.",
       "2. SIADH (hyponatremia) — Small Cell Carcinoma.",
       "• Others: Ectopic ACTH → Cushing's (SCLC), Lambert-Eaton syndrome, HPO."]),
    ]
))

# 10. Atherosclerosis (Page 12)
story.append(spotter_block(10, "Atherosclerosis of Aorta (Gross)",
    [12],
    [("Clinical scenario:",
      ["Post mortem of 50-year-old obese man; lesion on aorta."]),
     ("Q1. Identify the lesion.",
      ["Diagnosis: Atherosclerosis of the Aorta.",
       "• Gross: Yellow-white elevated plaques (atheromas) on the intima.",
       "• Advanced: calcification, ulceration, overlying thrombus.",
       "• Comparison of arterial diseases:",
       "  - Atherosclerosis: Intima, lipid plaques.",
       "  - Monckeberg's sclerosis: Media, calcification, lumen INTACT.",
       "  - Arteriolosclerosis: Small arteries/arterioles, hyaline or hyperplastic."]),
     ("Q2. Two complications:",
      ["1. Plaque rupture → Thromboembolism → Myocardial Infarction, Stroke.",
       "2. Aortic Aneurysm → wall weakening → rupture (catastrophic).",
       "• Others: Peripheral artery disease, chronic kidney disease, mesenteric ischemia."]),
    ]
))

# 11. Colorectal Ca — Right colon (Page 13)
story.append(spotter_block(11, "Colorectal Carcinoma — Right Colon / Exophytic (Gross)",
    [13],
    [("Clinical scenario:",
      ["74-year-old man with rectal bleeding. Colon specimen shown."]),
     ("Q1. Diagnosis with two identification points:",
      ["Diagnosis: Proximal (Right-sided) Colorectal Adenocarcinoma.",
       "• ID point 1: Thickening of wall with ulcerative-type growth.",
       "• ID point 2: Fungating/polypoid (exophytic) mass projecting into lumen with ulceration.",
       "• Presents with occult bleeding / iron deficiency anemia (not obstruction)."]),
     ("Q2. Two gross morphological types:",
      ["1. Polypoid/Exophytic (fungating) — right (proximal) colon; bleeds occultly.",
       "2. Annular/Napkin ring (ulcerative, constricting) — left (distal) colon; causes obstruction."]),
    ]
))

# 12. Napkin Ring CRC (Page 14)
story.append(spotter_block(12, "Colorectal Carcinoma — Napkin Ring Type (Gross)",
    [14],
    [("Clinical scenario:",
      ["72-year-old man with large bowel obstruction."]),
     ("Q1. Diagnosis. Two causes of large bowel obstruction:",
      ["Diagnosis: Distal (Left-sided) Colorectal Carcinoma — Napkin Ring / Annular type.",
       "• Gross features: Napkin ring constriction, annular growth, ulcerated surface.",
       "• Cause 1: Colorectal adenocarcinoma (most common cause in adults > 50 yrs).",
       "• Cause 2: Diverticular disease / Sigmoid volvulus."]),
     ("Q2. What is Napkin Ring growth?",
      ["Circumferential, constricting, annular carcinoma encircling the colon wall like a napkin ring.",
       "• Predominantly in the LEFT (sigmoid/descending) colon.",
       "• Results in progressive luminal narrowing → obstruction.",
       "• Microscopy: Moderately differentiated adenocarcinoma with 'dirty necrosis' in glands."]),
    ]
))

# 13. Intestinal Gangrene (Page 15)
story.append(spotter_block(13, "Intestinal Gangrene (Gross Specimen)",
    [15],
    [("Clinical scenario:",
      ["24-year-old man, acute pain abdomen. Intestinal specimen given."]),
     ("Q1. Diagnosis and two identification points:",
      ["Diagnosis: Gangrenous Intestine.",
       "• ID point 1: Blackened, hemorrhagic, friable intestinal segment with loss of normal sheen.",
       "• ID point 2: Clear line of demarcation between viable and necrotic bowel.",
       "• Gangrenous necrosis = coagulative + liquefactive necrosis (limbs or intestine)."]),
     ("Q2. One cause:",
      ["Volvulus (intestinal twisting) → venous obstruction → arterial occlusion → ischemia.",
       "• Other causes: Obstruction (adhesions, hernia), mesenteric artery thrombosis/embolism.",
       "• Types of necrosis review:",
       "  - Coagulative: heart, kidney",
       "  - Liquefactive: brain, abscess",
       "  - Caseous: TB",
       "  - Fat: pancreatitis, breast",
       "  - Fibrinoid: vessels",
       "  - Gangrenous: limb, intestine"]),
    ]
))

# 14. Leiomyoma (Page 16)
story.append(spotter_block(14, "Leiomyoma (Fibroid) of Uterus (Gross)",
    [16],
    [("Clinical scenario:",
      ["40-year-old female, menorrhagia × 3 years. Hysterectomy done."]),
     ("Q1. Diagnosis:",
      ["Diagnosis: Leiomyoma (Uterine Fibroid).",
       "• Gross: Solid, grey-white, well-circumscribed, rubbery nodular mass; whorled cut surface.",
       "• Estrogen-dependent; most common benign gynecological tumor.",
       "• Types: Intramural (most common), Submucosal (→ menorrhagia), Subserosal.",
       "• Also may present as cutaneous or vascular leiomyoma."]),
     ("Q2. Malignant counterpart:",
      ["Leiomyosarcoma.",
       "• Also may occur in: Colon, intestine (GI leiomyosarcoma).",
       "• Malignancy criteria: Mitotic count (>10 MF/10 HPF), nuclear atypia, coagulative necrosis."]),
    ],
    note="GIST (Gastrointestinal Stromal Tumor) — mesenchymal tumor from Cajal cells, CD117+, c-KIT mutation, treated with Imatinib."
))

# 15. Melanoma (Page 18)
story.append(spotter_block(15, "Malignant Melanoma (Gross / Clinical)",
    [18],
    [("Clinical scenario:",
      ["56-year-old female, increased itching in pre-existing mole."]),
     ("Q1. Diagnosis:",
      ["Diagnosis: Malignant Melanoma.",
       "• Most aggressive skin cancer; arises from melanocytes (neural crest cell origin)."]),
     ("Q2. Two identification features (ABCDE rule):",
      ["1. Asymmetry — irregular, non-uniform shape.",
       "2. Border irregularity — notched, scalloped edges.",
       "C. Color variation — multiple shades (black, brown, red, white, blue).",
       "D. Diameter > 6 mm.",
       "E. Evolution — changing lesion.",
       "• IHC markers: S100, HMB45, PRAME (prime marker), Melan-A.",
       "• Prognosis: Breslow thickness (depth of invasion) is the single most important prognostic factor."]),
    ]
))

# 16. Metastatic Liver (Page 19)
story.append(spotter_block(16, "Metastatic (Secondary) Carcinoma of Liver (Gross)",
    [19],
    [("Clinical scenario:",
      ["60-year-old female, breast lump (confirmed malignancy), died 3 months after chemo. Post-mortem liver shown."]),
     ("Q1. Identify the lesion.",
      ["Diagnosis: Metastatic (Secondary) Carcinoma of the Liver.",
       "• Gross: Multiple discrete, white-grey rounded nodules of varying sizes throughout both lobes.",
       "• Central umbilication (dimpling) due to central necrosis — classical.",
       "• Liver is the most common site for metastasis (portal + systemic blood supply)."]),
     ("Q2. Routes of spread of malignant tumors:",
      ["1. Lymphatic spread — most common for carcinomas (epithelial tumors).",
       "2. Hematogenous spread — most common for sarcomas; veins (portal → liver; systemic → lung).",
       "3. Transcoelomic (peritoneal) spread — ovarian, gastric, colonic cancers → 'carcinomatosis peritonei'.",
       "4. Direct/contiguous extension — to adjacent structures.",
       "5. Perineural spread — especially head/neck, prostate cancers.",
       "• Most common primaries metastasizing to liver: Breast, Colon, Stomach, Lung, Pancreas."]),
    ]
))

# 17. Ovarian Teratoma (Page 20)
story.append(spotter_block(17, "Mature Cystic Teratoma — Dermoid Cyst (Ovary, Gross)",
    [20],
    [("Clinical scenario:",
      ["Young female with left ovarian mass."]),
     ("Q1. Diagnosis:",
      ["Diagnosis: Mature Cystic Teratoma (Dermoid Cyst) of Ovary.",
       "• Most common ovarian germ cell tumor; >95% benign.",
       "• Contains elements from ALL 3 germ layers."]),
     ("Q2. Two identification points:",
      ["1. Mature teeth (calcified dental tissue) visible in the mass — gross.",
       "2. Cystic mass filled with sebaceous/greasy material, hair, and possibly teeth or bone.",
       "• Micro: Lined by keratinizing squamous epithelium; skin adnexa (hair follicles, sebaceous glands); cartilage, bone, bronchial epithelium from other germ layers.",
       "• Immature teratoma (malignant): Contains immature neuroepithelium.",
       "• Struma ovarii: Teratoma where thyroid tissue predominates (may cause hyperthyroidism)."]),
    ]
))

# 18. Osteosarcoma (Page 21)
story.append(spotter_block(18, "Osteosarcoma (Gross Specimen)",
    [21],
    [("Clinical scenario:",
      ["14-year-old girl, painful mass right knee, progressively increasing."]),
     ("Q1. Diagnosis and two identification points:",
      ["Diagnosis: Osteosarcoma (Osteogenic Sarcoma).",
       "• Most common primary malignant bone tumor in adolescents.",
       "• ID point 1: Destructive metaphyseal lesion with cortical destruction and sunburst periosteal reaction on X-ray.",
       "• ID point 2: Hard, gritty cut surface due to osteoid/tumor bone production."]),
     ("Q2. Codman's Triangle:",
      ["Radiological sign seen in osteosarcoma.",
       "• When the expanding tumor lifts the periosteum, reactive bone is laid down at the angle between elevated periosteum and cortex.",
       "• On X-ray: triangular shadow at the edge of the tumor.",
       "• Not specific to osteosarcoma — also in Ewing's sarcoma, osteomyelitis.",
       "• Note: Examiner noted 'Will not be asked' — but know it anyway!"]),
    ]
))

# 19. Diabetic Foot (Page 22)
story.append(spotter_block(19, "Diabetic Foot — Gangrene (Gross)",
    [22],
    [("Clinical scenario:",
      ["65-year-old diabetic male, pain and discoloration of foot."]),
     ("Q1. Identify the lesion.",
      ["Diagnosis: Diabetic Foot Gangrene.",
       "• Triad: Peripheral artery disease (atherosclerosis) + Neuropathy + Infection.",
       "• Gross: Blackened necrotic toes/forefoot with or without moist infected areas."]),
     ("Q2. Two more complications of Diabetes Mellitus:",
      ["1. Diabetic Nephropathy — Kimmelstiel-Wilson nodules; progressive CKD → ESRD.",
       "2. Diabetic Retinopathy — proliferative retinopathy, neovascularization → blindness.",
       "• Other DM complications: Peripheral neuropathy, Diabetic ketoacidosis, Hyperosmolar coma,",
       "  Increased susceptibility to infections, Accelerated atherosclerosis, Cardiomyopathy."]),
    ]
))

# 20. Giant Cell Tumor (Page 23)
story.append(spotter_block(20, "Giant Cell Tumor of Bone (Gross)",
    [23],
    [("Clinical scenario:",
      ["40-year-old lady, swelling near left knee. Amputation specimen."]),
     ("Q1. Diagnosis:",
      ["Diagnosis: Giant Cell Tumor of Bone (GCT / Osteoclastoma).",
       "• Epiphyseal tumor, adults 20-40 years, around knee most common.",
       "• Locally aggressive; ~5-10% malignant transformation."]),
     ("Q2. Two typical radiological features:",
      ["1. Soap bubble appearance — lytic lesion with thin bony trabeculae giving bubbly look on X-ray.",
       "2. Eccentric, epiphyseal lytic lesion extending to subchondral bone with no periosteal reaction.",
       "• Also: 'Beveled edge' / 'Fallen leaf' sign.",
       "• Micro: Sheets of mononuclear stromal cells + scattered osteoclast-like multinucleated giant cells."]),
    ]
))

# 21. Chondrosarcoma (Page 24)
story.append(spotter_block(21, "Chondrosarcoma (Gross Specimen)",
    [24],
    [("Clinical scenario:",
      ["70-year-old lady, swelling over hip bone."]),
     ("Q1. Diagnosis and two identification points:",
      ["Diagnosis: Chondrosarcoma.",
       "• Malignant cartilaginous tumor; most common in adults > 40 years.",
       "• ID point 1: Large, lobulated, grey-white translucent mass with glistening 'hyaline cartilage' appearance.",
       "• ID point 2: Areas of calcification, myxoid change, and possible cortical destruction.",
       "• Common sites: Pelvis, femur, humerus, scapula, ribs."]),
     ("Q2. Benign counterpart:",
      ["Enchondroma (intramedullary) / Osteochondroma (exostosis).",
       "• Enchondroma: Small, lobulated, no atypia; common in small bones of hand.",
       "• Osteochondroma: Exostosis with cartilage cap; most common benign bone tumor.",
       "• Chondrosarcoma: Large, lobulated, cellular atypia, may metastasize (hematogenous → lungs)."]),
    ]
))

# 22. Colloid Goiter (Page 25)
story.append(spotter_block(22, "Colloid Goiter — Multinodular Goiter (Gross)",
    [25],
    [("Identification points:",
      ["Specimen of thyroid gland.",
       "• Asymmetric enlargement of thyroid.",
       "• Multiple nodules containing colloid material, separated by thin fibrous strands."]),
     ("Q1. Define Goiter:",
      ["Goiter = any enlargement of the thyroid gland, regardless of cause or functional status."]),
     ("Q2. Commonest cause of goiter:",
      ["Iodine deficiency (worldwide most common cause — endemic/simple goiter).",
       "• In iodine-sufficient areas: Autoimmune (Hashimoto's thyroiditis) most common."]),
     ("Q3. Hypothyroidism vs Hyperthyroidism key differences:",
      ["• Hypothyroidism: Weight gain, cold intolerance, bradycardia, dry skin, constipation, myxedema.",
       "• Hyperthyroidism: Weight loss, heat intolerance, tachycardia, sweating, diarrhea, tremors.",
       "• TSH: High in hypothyroidism; Low in hyperthyroidism."]),
     ("Q4. Patient with colloid goiter — mostly euthyroid, hypothyroid, or hyperthyroid?",
      ["Mostly EUTHYROID (or mildly hypothyroid).",
       "• Large colloid goiter with multiple nodules = multinodular goiter, usually euthyroid."]),
     ("Q5. Complications of colloid goiter:",
      ["1. Tracheal/esophageal compression → dyspnea, dysphagia.",
       "2. Toxic nodular goiter → secondary thyrotoxicosis.",
       "3. Hemorrhage into nodule → sudden painful enlargement.",
       "4. Malignant transformation (rare)."]),
    ]
))

# 23. Metastatic Liver Detailed (Page 26)
story.append(spotter_block(23, "Metastatic Carcinoma Liver — Detailed (Gross)",
    [26],
    [("Identification points:",
      ["Specimen of Liver.",
       "• On cut section: multiple grey-white small nodules of metastatic deposits."]),
     ("Q1. Route of metastasis:",
      ["Hematogenous spread (most common to liver) — via portal venous system from GI tract,",
       "or via hepatic artery from systemic circulation."]),
     ("Q2. Three sites from where metastasis can occur in liver:",
      ["1. Colorectal carcinoma (most common — via portal vein).",
       "2. Breast carcinoma (hematogenous).",
       "3. Gastric carcinoma / Pancreatic carcinoma / Lung carcinoma."]),
     ("Q3. Differentiate from Primary HCC grossly:",
      ["Metastatic: Multiple bilateral nodules, umbilicated centers, usually no cirrhotic background.",
       "Primary HCC: Usually single large mass (or multifocal in cirrhotic liver), greenish-yellow (bile), ",
       "  vascular invasion common, set against cirrhotic liver parenchyma."]),
    ]
))

# 24. Cholelithiasis / Cholecystitis (Page 27)
story.append(spotter_block(24, "Cholelithiasis / Cholecystitis (Gross)",
    [27],
    [("Identification points:",
      ["Specimen of gallbladder.",
       "• Serosal surface: congested blood vessels.",
       "• Thickened wall.",
       "• Lumen: multiple stones."]),
     ("Q1. Types of gallstones:",
      ["1. Cholesterol stones (10-15%): Pure, single, oval, yellow, faceted. 5 Fs: Fat, Female, Forty, Fertile, Fair.",
       "2. Mixed stones (80%): Calcium salts + cholesterol + pigment; multiple, faceted, yellowish-brown.",
       "3. Pigment stones (10-15%): Black (sterile bile, hemolysis) or Brown (infected bile, E. coli)."]),
     ("Q2. What is Strawberry Gallbladder?",
      ["Cholesterolosis of gallbladder.",
       "• Yellow cholesterol deposits in the mucosa against a red, hyperemic background.",
       "• Resembles the surface of a strawberry.",
       "• Not premalignant; associated with cholesterol supersaturation."]),
     ("Q3. Classical clinical setting for gallstones:",
      ["5 Fs: Fat, Female, Forty, Fertile, Fair-skinned.",
       "• Plus: Rapid weight loss, TPN, hemolytic anemia (pigment stones), Crohn's disease."]),
    ]
))

# 25. Liver Cirrhosis (Page 28)
story.append(spotter_block(25, "Cirrhosis of Liver (Gross Specimen)",
    [28],
    [("Identification points:",
      ["Specimen of liver and gallbladder.",
       "• Multiple elevated nodules involving the entire liver parenchyma.",
       "• Nodules separated by pale fibrous bands."]),
     ("Q1. Microscopic features of Cirrhosis:",
      ["1. Disruption of normal hepatic lobular architecture.",
       "2. Regenerating hepatocyte nodules surrounded by fibrous septa.",
       "3. Fibrous septa contain chronic inflammatory cells.",
       "4. Loss of central veins and portal tracts in their normal relationship."]),
     ("Q2. Two morphological types with examples:",
      ["1. Micronodular cirrhosis: All nodules < 3 mm, uniform; caused by ALCOHOL.",
       "2. Macronodular cirrhosis: Nodules > 3 mm, varying sizes; caused by VIRAL HEPATITIS (HBV/HCV)."]),
     ("Q3. Etiological causes — commonest:",
      ["Most common worldwide: Viral hepatitis (HBV/HCV).",
       "• Alcohol (most common in Western countries).",
       "• Other: Wilson's disease, Hemochromatosis, Autoimmune hepatitis, PBC, PSC, Cryptogenic."]),
    ]
))

# 26. Amoebic Liver Abscess (Page 29)
story.append(spotter_block(26, "Amoebic Liver Abscess (Gross Specimen)",
    [29],
    [("Identification points:",
      ["Specimen of liver.",
       "• Large abscess cavity with irregular margin and shaggy wall.",
       "• Cavity contains necrotic material ('anchovy sauce' pus).",
       "• Multiple smaller abscesses around main cavity."]),
     ("Q1. Causative organism:",
      ["Entamoeba histolytica."]),
     ("Q2. Route of infection:",
      ["Feco-oral route → large intestine → portal venous system → liver (right lobe most common)."]),
     ("Q3. How is the pus described? Does it contain organisms?",
      ["Pus: Thick, reddish-brown, odorless 'anchovy sauce' / 'chocolate sauce' pus.",
       "• Composition: Liquefied hepatocytes + debris (NOT frank pus).",
       "• Organisms (trophozoites) found at the WALL/PERIPHERY of abscess, NOT in the central pus."]),
     ("Q4. Complications of Amoebic Liver Abscess:",
      ["1. Rupture into right pleural cavity (most common) → empyema.",
       "2. Rupture into pericardium → pericarditis (left lobe abscess).",
       "3. Rupture into peritoneum → peritonitis.",
       "4. Secondary bacterial superinfection."]),
     ("Q5. Special stain:",
      ["PAS stain (Periodic Acid-Schiff) — trophozoites stain magenta/red.",
       "• Also: Trichrome stain."]),
     ("Q6. Gross differences — Amoebic vs. Pyogenic abscess:",
      ["Amoebic: Single large abscess, right lobe, anchovy sauce pus, no organisms in pus.",
       "Pyogenic: Multiple abscesses, any lobe, frank creamy pus with organisms, fever + rigors."]),
    ]
))

# 27. Ulcerative Colitis (Page 30)
story.append(spotter_block(27, "Ulcerative Colitis (Gross Specimen)",
    [30],
    [("Identification points:",
      ["Specimen of large intestine.",
       "• Mucosal surface ulcerated with NO intervening normal area (continuous involvement).",
       "• Islands of regenerating mucosa → Pseudopolyps.",
       "• Serosa and wall: unremarkable (UC is a mucosal disease)."]),
     ("Q1. What are Pseudopolyps?",
      ["Islands of regenerating/surviving mucosa surrounded by ulcerated areas.",
       "• They APPEAR polypoid but are not true polyps.",
       "• Seen in Ulcerative Colitis (and occasionally in Crohn's)."]),
     ("Q2. Where does UC start?",
      ["UC starts in the RECTUM and extends proximally (retrograde, continuous).",
       "• Always involves rectum.",
       "• May be limited to rectum (proctitis), left colon (proctosigmoiditis), or pancolitis."]),
     ("Q3. Gross differences — UC vs Crohn's Disease:",
      ["Feature          | UC                        | Crohn's Disease",
       "Location         | Rectum → proximal (colon only) | Any part of GI tract (mouth to anus)",
       "Distribution     | Continuous                | Skip lesions (patchy)",
       "Wall thickness   | Normal (mucosal only)     | Thickened (transmural)",
       "Ulcers           | Superficial               | Deep ('cobblestone', knife-like fissures)",
       "Pseudopolyps     | Present                   | Less common",
       "Fistulas/fissures| Absent                    | Present",
       "String sign (X-ray)| Absent                  | Present (strictures)"]),
    ]
))

# 28. Choriocarcinoma (Page 35)
story.append(spotter_block(28, "Choriocarcinoma (Gross / Clinical)",
    [35],
    [("Clinical scenario:",
      ["Young female, per-vaginal bleeding since childbirth 6 months back."]),
     ("Q1. Diagnosis and biochemical test:",
      ["Diagnosis: Choriocarcinoma (Gestational Trophoblastic Malignancy).",
       "• Biochemical test: Serum β-hCG (beta-Human Chorionic Gonadotropin).",
       "  → Markedly elevated; used for diagnosis AND monitoring treatment response.",
       "• Gross: Hemorrhagic, necrotic, dark-red friable uterine mass.",
       "• Follows: Normal pregnancy, hydatidiform mole, abortion, ectopic pregnancy.",
       "• Micro: Sheets of cytotrophoblast and syncytiotrophoblast; NO chorionic villi."]),
     ("Q2. Sites of metastasis:",
      ["1. Lungs (most common — 'cannonball' metastases on CXR).",
       "2. Vagina (second most common).",
       "3. Brain.",
       "4. Liver.",
       "5. Kidneys.",
       "• Highly sensitive to chemotherapy (methotrexate); excellent prognosis even with mets."]),
    ]
))

# ── Now microscopy spotters ───────────────────────────────────────────────────

# 29. Meningioma — Psammoma Bodies (Pages 44-45)
story.append(spotter_block(29, "Meningioma — Psammoma Bodies (Microscopy)",
    [44, 45],
    [("Q. CT scan shows dural mass compressing brain. What are Psammoma Bodies?",
      ["Psammoma Bodies = concentric ring-like layers of basophilic dystrophic calcification.",
       "• Seen between tumor cells arranged in whorls and fascicles.",
       "• Pathognomonic of Meningioma microscopically."]),
     ("Q. Two other conditions where Psammoma bodies are found:",
      ["1. Papillary Thyroid Carcinoma",
       "2. Serous (Papillary) Ovarian Carcinoma",
       "• Mnemonic @PSAMMOMaS:",
       "  P-apillary thyroid ca., S-erous ovarian ca., A-drenal (renal cell ca.), M-eningioma,",
       "  M-esothelioma, O-varian serous ca., P-rolactinoma, S-omatostatinoma."]),
    ]
))

# 30. Fatty Liver (Pages 46-47)
story.append(spotter_block(30, "Hepatic Steatosis (Fatty Liver) — Microscopy",
    [46, 47],
    [("Q2. Identify. Give two identification points.",
      ["Diagnosis: Hepatic Steatosis (Fatty change of liver) — Alcoholic.",
       "• ID point 1: Small clear vacuoles (microvesicular) in hepatocyte cytoplasm, coalescing into large vacuoles (macrovesicular).",
       "• ID point 2: Macrovesicular steatosis — nucleus pushed to periphery, giving signet ring appearance."]),
     ("Q. Alcoholic hepatitis specific features:",
      ["• GGT: Specific marker for alcoholic liver disease.",
       "• Ballooning degeneration of hepatocytes.",
       "• Mallory-Denk bodies (hyaline inclusions of cytokeratin intermediate filaments).",
       "• Mild lymphoplasmocytic + neutrophilic infiltration.",
       "• AST:ALT ratio > 2:1 in alcoholic liver disease."]),
     ("Alcoholic vs Non-alcoholic liver disease:",
      ["Alcoholic: IgG and IgA antibodies; AST:ALT > 2:1.",
       "Non-alcoholic (NAFLD/NASH): ANA, SMA antibodies; ALT > AST (ratio < 1:1)."]),
    ]
))

# 31. Acute Appendicitis Micro (Page 49)
story.append(spotter_block(31, "Acute Appendicitis — Microscopy",
    [49],
    [("Q. Identify organ. Diagnosis. Two points in favour.",
      ["Organ: Appendix.",
       "Diagnosis: Acute Appendicitis.",
       "• ID point 1: Mucosa with focal ulceration; TRANSMURAL infiltration by neutrophils — especially in muscularis propria (key diagnostic criterion).",
       "• ID point 2: Serosa shows congested blood vessels (periappendicitis).",
       "• Cause: Obstruction by faecolith (most common), lymphoid hyperplasia, foreign body."]),
    ]
))

# 32. Tubercular Lymphadenitis Micro (Pages 50-51)
story.append(spotter_block(32, "Tubercular Lymphadenitis — Microscopy",
    [50, 51],
    [("Q. 7-year-old girl, cervical lymph node, lymphadenopathy × 3 months, raised ESR.",
      ["Diagnosis: Tubercular Lymphadenitis.",
       "• Section from lymph node.",
       "• Multiple epithelioid cell granulomas with Langhans giant cells and central caseous necrosis.",
       "• Granulomas surrounded by lymphocytes and fibroblasts."]),
     ("Q. Special stain:",
      ["Ziehl-Neelsen (ZN) stain for Acid-Fast Bacilli (AFB).",
       "• AFB appear RED against blue background."]),
     ("Langhans Giant Cell:",
      ["Horseshoe (U-shaped) or peripheral ring arrangement of nuclei.",
       "• Formed by fusion of epithelioid macrophages.",
       "• Seen in TB, leprosy, fungal infections."]),
    ]
))

# 33. Lipoma Micro (Pages 53-54)
story.append(spotter_block(33, "Lipoma — Microscopy",
    [53, 54],
    [("Q. Female, painless soft mobile lump in thigh.",
      ["Diagnosis: Lipoma.",
       "• ID point 1: Well-circumscribed tumor with thin capsule.",
       "• ID point 2: Tumor composed of mature adipocytes (lipocytes) separated by thin fibrovascular stroma.",
       "• Cells are uniform — no atypia, no lipoblasts (distinguishes from liposarcoma)."]),
     ("Q1. Malignant counterpart:",
      ["Liposarcoma.",
       "• Key feature: Lipoblasts (multivacuolated cells with scalloped, indented nuclei)."]),
     ("Q2. Special stain for fat cells:",
      ["Oil Red-O stain — fat appears red/orange.",
       "• S100 protein — positive in both lipoma and liposarcoma (Schwann cell / NCC origin)."]),
    ]
))

# 34. Oral SCC Micro (Pages 55-56)
story.append(spotter_block(34, "Oral Squamous Cell Carcinoma — Microscopy",
    [55, 56],
    [("Q. 73-year-old male, tobacco chewer × 37 years, large ulceroproliferative growth inner cheek.",
      ["Diagnosis: Oral Squamous Cell Carcinoma (SCC)."]),
     ("Microscopic identification points:",
      ["• Sheets and cords of malignant squamous cells invading stroma.",
       "• Malignant cells: eosinophilic cytoplasm, vesicular nuclei, prominent nucleoli.",
       "• Malignant KERATIN PEARLS (concentric whorls of keratinizing cells) — well-differentiated SCC.",
       "• Intercellular bridges (desmosomes) between squamous cells.",
       "• Nuclear pleomorphism, hyperchromasia, atypical mitoses."]),
     ("Q. Three other sites for SCC:",
      ["1. Esophagus (middle third)",
       "2. Larynx / Pharynx",
       "3. Lung (central, associated with smoking)",
       "• Also: Skin, cervix uteri, urinary bladder (after metaplasia)."]),
    ]
))

# 35. Colorectal Adenocarcinoma Micro (Pages 57-58)
story.append(spotter_block(35, "Colorectal Adenocarcinoma — Microscopy",
    [57, 58],
    [("Q. 50-year-old male, bleeding per rectum. Diagnosis, 2 points, benign counterpart.",
      ["Diagnosis: Colorectal Adenocarcinoma.",
       "• ID point 1: Malignant glands of varying sizes in back-to-back pattern.",
       "• ID point 2: Malignant cells with pleomorphic, hyperchromatic nuclei and high N/C ratio, infiltrating smooth muscle bundles.",
       "• 'Dirty necrosis' — intraluminal necrotic debris in glands (characteristic).",
       "• Benign counterpart: Colorectal Adenoma (Adenomatous Polyp)."]),
    ]
))

# 36. Arterial Thrombosis Micro (Pages 59-60)
story.append(spotter_block(36, "Arterial Thrombosis — Microscopy",
    [59, 60],
    [("Q. 50-year-old female, lower calf pain, absent DP pulse.",
      ["Diagnosis: Organized Thrombus with Recanalization in artery.",
       "• ID point 1: Section from blood vessel showing organized thrombus with Lines of Zahn.",
       "• ID point 2: Thrombus shows recanalization (new vascular channels forming within thrombus).",
       "• Lines of Zahn: Alternating laminations of fibrin/platelets (light) and RBCs (dark) — confirms ante-mortem formation."]),
    ]
))

# 37. Chronic Venous Congestion Liver Micro (Pages 61-62)
story.append(spotter_block(37, "Chronic Venous Congestion of Liver — Microscopy",
    [61, 62],
    [("Q. Patient with right-sided heart failure.",
      ["Diagnosis: Chronic Passive Venous Congestion of Liver (Nutmeg Liver).",
       "• ID point 1: Dilated central veins.",
       "• ID point 2: Hemorrhagic necrosis of hepatocytes around central vein (centrilobular necrosis).",
       "• Portal triads visible; viable hepatocytes in periportal zone."]),
     ("Q. What are Heart Failure Cells?",
      ["Heart Failure Cells = Hemosiderin-laden macrophages.",
       "• Found in: Liver (centrilobular) and LUNGS (alveolar macrophages).",
       "• In lungs: RBCs extravasate into alveoli → macrophages ingest and store hemosiderin.",
       "• Stain: Prussian blue (iron stain)."]),
    ]
))

# 38. Actinomycosis (Pages 63-64)
story.append(spotter_block(38, "Actinomycosis — Microscopy",
    [63, 64],
    [("Q. 20-year-old female, abscess neck, yellow granular material from sinus.",
      ["Diagnosis: Actinomycosis.",
       "• Causative organism: Actinomyces israelii (Gram-positive bacillus in chains; true bacteria but resembles fungi).",
       "• The yellow granules = Sulfur granules."]),
     ("Microscopic identification points:",
      ["• Section shows an abscess.",
       "• Basophilic filamentous colonies in the center of the abscess.",
       "• Splendore-Hoeppli Phenomenon: Microorganism surrounded by radiating intensely eosinophilic 'rays' / club-shaped projections.",
       "• Gram-positive branching filaments (not acid-fast)."]),
     ("Clinical associations:",
      ["• Cervicofacial actinomycosis (most common form) — often after dental extraction/tonsillectomy.",
       "• Also: Thoracic, abdominal, pelvic actinomycosis."]),
    ]
))

# 39. Rhinosporidiosis (Pages 65-66)
story.append(spotter_block(39, "Rhinosporidiosis — Microscopy",
    [65, 66],
    [("Q. Patient with polypoid nasal mass and nasal obstruction.",
      ["Diagnosis: Rhinosporidiosis.",
       "• Causative agent: Rhinosporidium seeberi (a mesomycete/aquatic pathogen).",
       "• Endemic in South Asia (India, Sri Lanka)."]),
     ("Microscopic identification points:",
      ["• Tissue lined by pseudostratified ciliated columnar epithelium.",
       "• Sub-epithelium shows SPORANGIA of different sizes (small immature → large mature with endospores).",
       "• Chronic inflammatory infiltrate: lymphocytes and plasma cells.",
       "• Mature sporangium filled with endospores (large, blue globules)."]),
    ]
))

# 40. Lobar Pneumonia — Grey Hepatization (Pages 67-68)
story.append(spotter_block(40, "Lobar Pneumonia — Grey Hepatization (Microscopy)",
    [67, 68],
    [("Q. 7-year-old, high fever, rusty sputum. Lung biopsy.",
      ["Diagnosis: Lobar Pneumonia — Stage of Grey Hepatization.",
       "• Stage: Grey Hepatization (Day 3–8 of lobar pneumonia)."]),
     ("Microscopic identification points:",
      ["• Section shows lung parenchyma.",
       "• Alveolar spaces filled with neutrophils (degenerate PMNs).",
       "• Fibrin strands in alveoli.",
       "• Alveolar septa show carbon-laden macrophages.",
       "• RBCs lysed (hence grey, not red)."]),
     ("Stages of Lobar Pneumonia:",
      ["1. Congestion (Day 1-2): Vascular engorgement, edema fluid, bacteria.",
       "2. Red Hepatization (Day 3-4): RBCs + neutrophils + fibrin fill alveoli; liver-like red solid texture.",
       "3. Grey Hepatization (Day 5-7): RBCs lyse; fibrin + degenerate neutrophils remain; grey.",
       "4. Resolution (Day 8+): Enzymatic digestion, macrophage clearance, lung restored.",
       "• Organism: Streptococcus pneumoniae (most common).",
       "• Rusty sputum = blood-stained sputum from pneumococcal pneumonia."]),
    ]
))

# 41. Atherosclerosis Micro (Pages 69-70)
story.append(spotter_block(41, "Atherosclerosis — Microscopy",
    [69, 70],
    [("Q. Diabetic male with chest pain; coronary artery blocked. 3 causative factors, 2 complications.",
      ["Diagnosis: Atherosclerosis."]),
     ("Microscopic identification points:",
      ["• Section from blood vessel (artery).",
       "• Fibrous cap in intima: smooth muscle fibers + chronic inflammatory cells (macrophages/foam cells).",
       "• Central necrotic core: foamy macrophages (lipid-laden), cholesterol crystals, cell debris.",
       "• Neovascularization at plaque periphery."]),
     ("3 Causative factors:",
      ["1. Endothelial injury (by hypertension, smoking, hyperlipidemia, diabetes).",
       "2. High LDL cholesterol (and low HDL) → lipid accumulation in intima.",
       "3. Chronic inflammation and macrophage foam cell formation."]),
     ("2 Complications:",
      ["1. MI (myocardial infarction) — plaque rupture + thrombosis in coronary artery.",
       "2. Stroke — carotid/cerebral artery disease + thromboembolism.",
       "• Others: Peripheral artery disease, aneurysm, CKD."]),
    ]
))

# 42. Capillary Hemangioma (Pages 71-72)
story.append(spotter_block(42, "Capillary Hemangioma — Microscopy",
    [71, 72],
    [("Q. 20-year-old male, bleeding polypoid skin lesion.",
      ["Diagnosis: Capillary Hemangioma.",
       "• Benign vascular tumor of capillary-sized vessels."]),
     ("Microscopic identification points:",
      ["• Lobules of thin-walled capillaries lined by plump endothelial cells.",
       "• Connective tissue septa separate the lobules.",
       "• Most capillaries devoid of blood (empty lumen).",
       "• No nuclear atypia."]),
     ("Common sites:",
      ["• Skin (most common), liver, vertebrae, lungs."]),
    ]
))

# 43. Cavernous Hemangioma (Pages 73-74)
story.append(spotter_block(43, "Cavernous Hemangioma — Microscopy",
    [73, 74],
    [("Q. Patient with small reddish-blue soft mass, 1.5 cm on lip.",
      ["Diagnosis: Cavernous Hemangioma."]),
     ("Microscopic identification points:",
      ["• Large, dilated, blood-filled vascular spaces (cavernous spaces).",
       "• Lined by flattened endothelial cells.",
       "• Vascular spaces contain RBCs.",
       "• Scant intervening stroma.",
       "• Difference from capillary: spaces are LARGE (cavernous), not small capillaries."]),
    ]
))

# 44. Pulmonary TB Granuloma Micro (Pages 75-77)
story.append(spotter_block(44, "Pulmonary TB — Granuloma Microscopy",
    [75, 76, 77],
    [("Q. 60-year-old smoker + AIDS patient, weight loss, hemoptysis.",
      ["Diagnosis: Pulmonary Tuberculosis.",
       "• Section from lung: Multiple granulomas with epithelioid cells, Langhans giant cells, chronic inflammatory cells.",
       "• Some granulomas show central caseous necrosis."]),
     ("Q. What is Ghon's Focus?",
      ["Small primary granulomatous lesion in the lung (lower part of upper lobe or upper part of lower lobe).",
       "• Part of primary TB.",
       "• Subpleural location."]),
     ("Q. What is a Granuloma?",
      ["Chronic inflammatory lesion = collection of activated macrophages (epithelioid cells), often with giant cells, surrounded by lymphocytes.",
       "• Types:",
       "  - Caseating: Central necrosis — TB, Histoplasmosis.",
       "  - Non-caseating: No necrosis — Sarcoidosis, Crohn's, Berylliosis, Syphilis.",
       "  - Foreign body granuloma: Around inert material (sutures, talc).",
       "  - Immune granuloma: T-cell mediated — TB, Leprosy, Brucellosis."]),
    ]
))

# 45. Bronchogenic Ca — Paraneoplastic (Pages 78-79)
story.append(spotter_block(45, "Bronchogenic Carcinoma — Paraneoplastic Syndromes (Micro)",
    [78, 79],
    [("Q. Smoker with hemoptysis. 3 paraneoplastic syndromes, etiological factor.",
      ["Diagnosis: Bronchogenic Carcinoma."]),
     ("3 Paraneoplastic Syndromes:",
      ["1. SIADH → Hyponatremia — Small Cell Carcinoma (most common).",
       "2. Ectopic ACTH → Cushing's Syndrome — Small Cell Carcinoma.",
       "3. Hypercalcemia (PTHrP) → Squamous Cell Carcinoma.",
       "• Others: Lambert-Eaton myasthenic syndrome, Hypertrophic Pulmonary Osteoarthropathy (HPO)."]),
     ("Etiological factor:",
      ["Cigarette smoking (major — ~85% of lung cancers).",
       "• Others: Occupational (asbestos, radon, arsenic, chromium, nickel), air pollution, chronic lung disease."]),
    ]
))

# 46. Juvenile Rectal Polyp (Pages 80-81)
story.append(spotter_block(46, "Juvenile Rectal Polyp — Microscopy",
    [80, 81],
    [("Q. 8-year-old girl, bleeding per rectum, rectal mass.",
      ["Diagnosis: Juvenile (Hamartomatous) Rectal Polyp.",
       "• Commonest age group: Children < 5 years.",
       "• Nature: BENIGN (not premalignant in isolated cases)."]),
     ("Microscopic identification points:",
      ["• Polypoid tissue partially lined by columnar epithelium with surface ulceration.",
       "• Subepithelium: rectal glands lined by mucus-secreting columnar epithelium.",
       "• Glands: elongated or cystically dilated, filled with mucin.",
       "• Stroma: edematous with neutrophils, eosinophils, lymphocytes, plasma cells.",
       "• Proliferating capillaries forming granulation tissue."]),
    ]
))

# 47. Amyloid Kidney (Pages 82-83)
story.append(spotter_block(47, "Amyloid Kidney — Microscopy",
    [82, 83],
    [("Q. Identify lesion, points in favour, special stain.",
      ["Diagnosis: Renal Amyloidosis.",
       "• Clinical: Proteinuria, nephrotic syndrome."]),
     ("Microscopic identification points:",
      ["• Section from kidney.",
       "• Extracellular deposits of AMORPHOUS EOSINOPHILIC material mainly in glomeruli.",
       "• Capillary spaces almost obliterated.",
       "• Material is homogeneous, pale pink (eosinophilic) on H&E."]),
     ("Special stain:",
      ["Congo Red stain → salmon-pink color.",
       "• Under POLARIZED LIGHT: Apple-green birefringence (pathognomonic).",
       "• Amyloid = misfolded protein fibrils (AL, AA, or other types)."]),
    ]
))

# 48. Granulation Tissue (Pages 84-85)
story.append(spotter_block(48, "Granulation Tissue — Microscopy",
    [84, 85],
    [("Q. 47-year-old male, cut injury. Biopsy after 1 week.",
      ["Diagnosis: Granulation Tissue (part of healing process)."]),
     ("Microscopic identification points:",
      ["• Proliferating fibroblasts.",
       "• Thin-walled, congested capillaries (angiogenesis).",
       "• Chronic inflammatory cells (lymphocytes and plasma cells).",
       "• Loose, pale background stroma.",
       "• No necrosis — tissue is vital and repairing."]),
     ("Note:",
      ["Granulation tissue ≠ Granuloma.",
       "• Granulation tissue: Part of wound healing — fibroblasts + new capillaries.",
       "• Granuloma: Chronic inflammatory lesion — epithelioid macrophages + giant cells."]),
    ]
))

# 49. Ovarian Teratoma Micro (Pages 86-87)
story.append(spotter_block(49, "Ovarian Teratoma (Dermoid Cyst) — Microscopy",
    [86, 87],
    [("Q. Female with right ovarian mass.",
      ["Diagnosis: Mature Cystic Teratoma (Dermoid Cyst) of Ovary."]),
     ("Microscopic identification points:",
      ["• Section of ovary shows keratinized stratified squamous epithelium with flakes of keratin.",
       "• Underlying tissue shows sebaceous glands, sweat glands, muscle fibers, hair follicles, blood vessels, and cartilage.",
       "• Contains derivatives of all 3 germ layers."]),
     ("Q. Two common surface epithelial tumors of ovary:",
      ["1. Serous tumors (serous cystadenoma / cystadenocarcinoma) — most common.",
       "2. Mucinous tumors (mucinous cystadenoma / cystadenocarcinoma).",
       "• Both are surface epithelial tumors (arise from coelomic epithelium)."]),
    ]
))

# 50. Acute MI Micro (Pages 88-89)
story.append(spotter_block(50, "Acute Myocardial Infarction — Microscopy",
    [88, 89],
    [("Q. 56-year-old chronic smoker, acute severe chest pain, sweating, hypotension.",
      ["Diagnosis: Acute Myocardial Infarction (AMI)."]),
     ("Q. Test done in first 24 hours:",
      ["1. Troponin I / Troponin T (most sensitive + specific) — rises 3-4 hrs, lasts 7-10 days.",
       "2. CK-MB — rises 3-6 hrs, normalizes 48-72 hrs (useful for reinfarction).",
       "3. ECG — ST elevation (STEMI) or ST depression (NSTEMI)."]),
     ("Q. Two causes:",
      ["1. Coronary atherosclerosis (> 90% of cases).",
       "2. Thrombosis on ruptured plaque (acute plaque rupture + superimposed thrombus)."]),
     ("Microscopic identification points (infarct zone):",
      ["• Myocardial muscle fibers appear wavy and eosinophilic.",
       "• Coagulative necrosis — ghost outlines of myocytes.",
       "• Hemorrhage in necrotic zone.",
       "• Infiltration by neutrophils (within 6-24 hrs).",
       "• Later: macrophages (days 2-4), granulation tissue (week 2), fibrosis (weeks 4-8)."]),
    ]
))

# 51. Schwannoma (Pages 90-91)
story.append(spotter_block(51, "Schwannoma (Neurilemmoma) — Microscopy",
    [90, 91],
    [("Q. Well-circumscribed encapsulated tumor attached to a nerve.",
      ["Diagnosis: Schwannoma (Neurilemmoma).",
       "• Benign nerve sheath tumor arising from Schwann cells.",
       "• Gross: Well-circumscribed, encapsulated; nerve pushed aside (NOT invaded)."]),
     ("Microscopic identification points:",
      ["• Antoni A areas: DENSELY cellular — spindle-shaped Schwann cells in palisades forming VEROCAY BODIES.",
       "• Antoni B areas: LOOSELY textured — hypocellular, myxoid stroma, microcysts.",
       "• IHC: S100 positive (Schwann cell marker).",
       "• No mitotic figures (benign)."]),
    ]
))

# 52. Papillary Carcinoma Thyroid (Pages 93-94)
story.append(spotter_block(52, "Papillary Carcinoma of Thyroid — Microscopy",
    [93, 94],
    [("Microscopic identification points:",
      ["• Section of thyroid gland.",
       "• Tumor cells arranged in PAPILLARY PATTERN with central fibrovascular core.",
       "• Nuclei: 'Ground glass' / 'Orphan Annie eye' nuclei — optically clear, empty-looking.",
       "• Nuclear pseudo-inclusions and nuclear grooving.",
       "• PSAMMOMA BODIES in some papillae (concentric calcifications)."]),
     ("Key facts:",
      ["• Most common thyroid malignancy.",
       "• Best prognosis of all thyroid cancers.",
       "• Spreads via LYMPHATICS (regional nodes).",
       "• Associated with: Radiation exposure, RET/PTC rearrangement, BRAF mutation.",
       "• 'Orphan Annie eye' = hallmark nuclear feature."]),
    ]
))

# 53. Follicular Carcinoma Thyroid (Pages 95-96)
story.append(spotter_block(53, "Follicular Carcinoma of Thyroid — Microscopy",
    [95, 96],
    [("Microscopic identification points:",
      ["• Section of thyroid gland.",
       "• Tumor composed of closely packed thyroid follicles — uniformly SMALL (microfollicles).",
       "• CAPSULAR INVASION (follicles breaking through fibrous capsule) — KEY diagnostic feature.",
       "• Vascular invasion also characteristic."]),
     ("Key facts:",
      ["• Second most common thyroid malignancy.",
       "• CANNOT be diagnosed on FNAC alone (need capsular/vascular invasion on histology).",
       "• Spreads via HEMATOGENOUS route (vs. lymphatic in papillary ca.).",
       "• Common metastasis sites: Bones (vertebrae, ribs, skull), Lungs, Liver, Brain.",
       "• Associated with: Iodine deficiency, RAS mutation, PAX8-PPARgamma translocation."]),
    ]
))

# 54. Thyrotoxicosis (Pages 97-99)
story.append(spotter_block(54, "Thyrotoxicosis (Graves'/Toxic Goiter) — Microscopy",
    [97, 99],
    [("Microscopic identification points:",
      ["• Section of thyroid gland.",
       "• Thyroid follicles of varying sizes lined by follicular cells containing colloid.",
       "• Follicular cells appear tall (columnar) with scalloping of colloid margins (resorption lacunae).",
       "• Secondary changes: hemorrhage, fibrosis, cystic change."]),
     ("Q. 3 Important features of thyrotoxicosis:",
      ["1. Weight loss DESPITE increased appetite — hypermetabolism.",
       "2. Tachycardia/palpitations — cardiovascular effects of excess T3/T4.",
       "3. Nervous system hyperactivity: tremors, anxiety, heat intolerance, sweating.",
       "• Mnemonic @FAST: Fat loss, Anxiety, Sweating, Tachycardia."]),
    ]
))

# 55. Wilms Tumor (Pages 101-102)
story.append(spotter_block(55, "Wilms Tumor (Nephroblastoma) — Microscopy",
    [101, 102],
    [("Microscopic identification points:",
      ["Diagnosis: Wilms' Tumor (Nephroblastoma).",
       "• Most common renal malignancy in children (peak: 2-5 years).",
       "• Triphasic pattern — 3 components:",
       "  1. BLASTEMAL cells: Primitive, small, blue cells with scant cytoplasm, high N/C ratio.",
       "  2. EPITHELIAL component: Abortive tubules and glomeruli.",
       "  3. STROMAL component: Spindle cells, cartilage, muscle.",
       "• Associated with WT1 gene mutation (chromosome 11p13).",
       "• WAGR syndrome: Wilms + Aniridia + Genitourinary anomalies + Retardation."]),
    ]
))

# 56. Chronic Cholecystitis (Pages 103-104)
story.append(spotter_block(56, "Chronic Cholecystitis — Microscopy",
    [103, 104],
    [("Q. 46-year-old obese female, colicky RUQ pain, abdominal bloating.",
      ["Diagnosis: Chronic Cholecystitis (usually associated with gallstones)."]),
     ("Microscopic findings (2 in favour):",
      ["1. Rokitansky-Aschoff Sinuses: Mucosal invaginations penetrating into the muscle layer (pathognomonic).",
       "2. Muscularis propria is HYPERTROPHIED.",
       "• Mucosa: lined by columnar epithelium; mucosal fibrosis with epithelial atrophy.",
       "• Chronic inflammatory cell infiltrate in all layers.",
       "• Xanthogranulomatous cholecystitis: foam cells (lipid-laden macrophages) in wall."]),
    ]
))

# 57. Liver Cirrhosis Micro (Pages 105-107)
story.append(spotter_block(57, "Liver Cirrhosis — Microscopy",
    [105, 107],
    [("Microscopic identification points:",
      ["Diagnosis: Cirrhosis of Liver.",
       "• Section from liver.",
       "• Liver architecture is DISRUPTED.",
       "• Regenerating liver nodules of varying sizes.",
       "• Separated by fibrous septa (which contain chronic inflammatory cells).",
       "• Central veins and portal tracts no longer in normal relationships."]),
    ]
))

# 58. Colorectal Adenocarcinoma Micro 2 (Pages 108-110)
story.append(spotter_block(58, "Colorectal Adenocarcinoma — Microscopy (Detailed)",
    [108, 110],
    [("Microscopic identification points:",
      ["Diagnosis: Colorectal Adenocarcinoma.",
       "• Section shows colonic mucosa with goblet cells.",
       "• Malignant cells arising from mucosa, infiltrating through muscularis propria to serosa.",
       "• Malignant cells in acinar/glandular pattern, nests and sheets.",
       "• Cells: moderate cytoplasm, pleomorphic vesicular nuclei, prominent nucleoli, atypical mitoses.",
       "• Intervening stroma: lymphoplasmacytic infiltration.",
       "• 'Dirty necrosis': necrotic debris in gland lumina (characteristic of colorectal Ca)."]),
    ]
))

# 59. Juvenile Polyp Micro 2 (Pages 111-112)
story.append(spotter_block(59, "Juvenile Polyp — Microscopy (Detailed)",
    [111, 112],
    [("Microscopic identification points:",
      ["• Polyp lined by columnar epithelium.",
       "• Underlying glands of varying sizes — some cystically dilated, filled with mucin.",
       "• Stroma: edematous with chronic inflammatory cells and capillaries.",
       "• No dysplasia (distinguishes from adenomatous polyp).",
       "• Glands lined by mucin-secreting cuboidal to columnar epithelium."]),
    ]
))

# 60. Intestinal TB (Pages 113-115)
story.append(spotter_block(60, "Intestinal Tuberculosis — Microscopy",
    [113, 115],
    [("Microscopic identification points:",
      ["Diagnosis: Intestinal Tuberculosis.",
       "• Section from intestine.",
       "• Epithelioid granulomas with Langhans giant cells and lymphocytes.",
       "• Areas of CASEOUS NECROSIS.",
       "• Transmural involvement (all layers).",
       "• Ulceration of mucosa (transverse ulcers in ileocecal region)."]),
     ("Routes of spread to intestine:",
      ["1. Hematogenous spread from primary pulmonary focus (miliary TB).",
       "2. Lymphatic spread from mesenteric lymph nodes.",
       "3. Direct spread from adjacent organs (peritoneum, fallopian tubes).",
       "4. Ingestion of infected sputum from active pulmonary TB."]),
    ]
))

# 61. Diffuse Gastric Ca (Pages 116-118)
story.append(spotter_block(61, "Diffuse Gastric Carcinoma — Signet Ring Cell (Microscopy)",
    [116, 118],
    [("Microscopic identification points:",
      ["Diagnosis: Diffuse Gastric Carcinoma (Signet Ring Cell type).",
       "• Section shows gastric mucosa with gastric glands.",
       "• Malignant cells infiltrating through muscularis propria to serosa.",
       "• SIGNET RING CELLS: vacuolated cytoplasm + eccentric, compressed nucleus (pushed to periphery by mucin).",
       "• Hyperchromatic, pleomorphic nuclei, atypical mitoses.",
       "• Stroma: chronic lymphoplasmacytic infiltration.",
       "• Leads to 'Linitis plastica' — leather bottle stomach (diffuse wall thickening)."]),
    ]
))

# 62. Intestinal-type Gastric Ca (Pages 119-121)
story.append(spotter_block(62, "Intestinal-type Gastric Carcinoma — Microscopy",
    [119, 121],
    [("Microscopic identification points:",
      ["Diagnosis: Intestinal-type Gastric Adenocarcinoma.",
       "• Malignant cells arranged in ACINI (glands) and nests.",
       "• Cells: moderate cytoplasm, hyperchromatic nuclei, prominent nucleoli.",
       "• Stroma: lymphoplasmacytic infiltration.",
       "• Associated with: H. pylori, intestinal metaplasia, chronic atrophic gastritis."]),
     ("Mode of metastasis:",
      ["Primary: Lymphatic (regional lymph nodes).",
       "Distant: Liver (hematogenous via portal), Peritoneum (transcoelomic).",
       "• Special metastases: Krukenberg tumor (bilateral ovaries via transcoelomic/hematogenous),",
       "  Sister Mary Joseph nodule (umbilicus)."]),
    ]
))

# 63. Pleomorphic Adenoma (Pages 122-124)
story.append(spotter_block(63, "Pleomorphic Adenoma (Mixed Tumor) of Parotid — Microscopy",
    [122, 124],
    [("Microscopic identification points:",
      ["Diagnosis: Pleomorphic Adenoma (Benign Mixed Tumor) of Parotid Gland.",
       "• Most common salivary gland tumor.",
       "• Section shows MIXED composition:",
       "  - Epithelial component: cells forming ducts, cords and acini.",
       "  - Myoepithelial component.",
       "  - Stromal component: chondromyxoid material and cartilage (hence 'mixed')."]),
     ("Other benign parotid tumors:",
      ["• Warthin tumor (papillary cystadenoma lymphomatosum): Double layer oncocytic epithelium + lymphoid stroma.",
       "• Canalicular adenoma.",
       "• Basal cell adenoma.",
       "• Malignant transformation: Carcinoma ex pleomorphic adenoma."]),
    ]
))

# 64. Oral SCC Micro 2 (Pages 125-127)
story.append(spotter_block(64, "Oral SCC — Microscopy (Detailed)",
    [125, 127],
    [("Microscopic identification points:",
      ["Diagnosis: Squamous Cell Carcinoma — Oral Cavity.",
       "• Section shows tissue lined by stratified squamous epithelium.",
       "• Underlying stroma: infiltrating malignant squamous cells in sheets, nests and whorls.",
       "• Malignant cells: moderate eosinophilic cytoplasm, pleomorphic nuclei, prominent nucleoli, atypical mitoses.",
       "• KERATIN PEARLS: Concentric whorls of keratin at center of tumor nests (well-differentiated SCC).",
       "• Intercellular bridges (desmosomes) between cells."]),
    ]
))

# 65. Melanoma Micro (Pages 128-130)
story.append(spotter_block(65, "Malignant Melanoma — Microscopy",
    [128, 129, 130],
    [("Microscopic identification points:",
      ["Diagnosis: Malignant Melanoma.",
       "• Epithelium shows PAGETOID spread (single malignant melanocytes spreading in epidermis).",
       "• Marked pleomorphism — bizarre, large nuclei.",
       "• Variable inflammatory infiltrate (brisk, non-brisk, or absent).",
       "• Dermal fibrosis.",
       "• Irregular distribution of melanin pigment.",
       "• Invasion into dermis (Breslow thickness determines prognosis)."]),
     ("IHC markers:",
      ["• S100 (neural crest cell origin) — most sensitive.",
       "• HMB45 — most specific.",
       "• PRAME — prime marker (most recently validated).",
       "• Melan-A (MART-1).",
       "• MYO1 (Myosin 1)."]),
     ("ABCDE rule:",
      ["A: Asymmetry, B: Border irregularity, C: Color variation,",
       "D: Diameter > 6mm, E: Evolution.",
       "• May also present in nipple (Paget's disease of nipple — search for underlying breast malignancy)."]),
    ]
))

# Final page
story.append(PageBreak())
story.append(Spacer(1, 1*cm))
story.append(HR(2, '#000000'))
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("END OF OSPE ANSWER KEY", ParagraphStyle('END',
    parent=styles['Normal'], fontSize=14, fontName='Helvetica-Bold',
    alignment=TA_CENTER, textColor=colors.black)))
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph(
    "65 spotters covered | Gross + Microscopy | All figures embedded from original OSPE PDF",
    ParagraphStyle('foot2', parent=styles['Normal'], fontSize=10,
    alignment=TA_CENTER, textColor=colors.HexColor('#555555'))))
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph(
    "Remember: Identify → Gross/Micro features → Causative organism/factor → Complications → Clinical correlation",
    ParagraphStyle('foot3', parent=styles['Normal'], fontSize=9,
    fontName='Helvetica-Oblique', alignment=TA_CENTER, textColor=colors.HexColor('#555555'))))

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