const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Endocrine Tumours of the Pancreas";
pres.subject = "Pancreatic Neuroendocrine Neoplasms (PanNENs)";

// ─── COLOUR PALETTE ───────────────────────────────────────────────────────────
const C = {
  navy:       "0D2B55",   // dominant dark (60%)
  teal:       "1A7A8A",   // supporting mid-tone
  amber:      "F0A500",   // accent / highlight
  white:      "FFFFFF",
  lightGray:  "EEF2F7",
  midGray:    "B0BEC5",
  textDark:   "1A1A2E",
  softBlue:   "1E3A5F",
  paleBlue:   "D6E4F0",
  gold:       "FFD166",
  green:      "2D9E6B",
  red:        "C0392B",
};

// ─── HELPERS ─────────────────────────────────────────────────────────────────
function addSlide(bg) {
  const s = pres.addSlide();
  s.background = { color: bg || C.white };
  return s;
}

function sectionTitle(slide, label) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.08, fill: { color: C.amber } });
  slide.addText(label, {
    x: 0, y: 0.08, w: 10, h: 0.5, fontSize: 10, bold: true, color: C.amber,
    align: "center", charSpacing: 3
  });
}

function mainTitle(slide, title, subtitle) {
  slide.addText(title, {
    x: 0.5, y: 0.9, w: 9, h: 1.4,
    fontSize: 38, bold: true, color: C.white, align: "center", fontFace: "Calibri"
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      x: 0.5, y: 2.45, w: 9, h: 0.6,
      fontSize: 18, color: C.gold, align: "center", fontFace: "Calibri", italic: true
    });
  }
}

function slideHeading(slide, title) {
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  slide.addText(title, {
    x: 0.4, y: 0.1, w: 9.2, h: 0.8, fontSize: 22, bold: true,
    color: C.white, fontFace: "Calibri", valign: "middle"
  });
}

function bullet(text, level, bold) {
  return {
    text: text,
    options: {
      bullet: { indent: 12 + (level || 0) * 14 },
      fontSize: level === 1 ? 14 : 16,
      bold: bold || false,
      color: level === 1 ? C.teal : C.textDark,
      breakLine: true,
      paraSpaceAfter: level === 1 ? 2 : 5
    }
  };
}

function addBullets(slide, items, x, y, w, h) {
  slide.addText(items, { x, y, w, h, fontFace: "Calibri", valign: "top" });
}

function colorBox(slide, x, y, w, h, color, text, textColor, fontSize) {
  slide.addShape(pres.ShapeType.roundRect, {
    x, y, w, h,
    fill: { color },
    line: { color: C.white, width: 1 },
    rectRadius: 0.08
  });
  if (text) {
    slide.addText(text, {
      x, y, w, h, fontSize: fontSize || 13, bold: true,
      color: textColor || C.white, align: "center", valign: "middle", fontFace: "Calibri"
    });
  }
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 1 – TITLE
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide(C.navy);
  // Decorative gradient band
  s.addShape(pres.ShapeType.rect, { x: 0, y: 4.3, w: 10, h: 1.325, fill: { color: C.softBlue } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: C.amber } });
  mainTitle(s, "Endocrine Tumours\nof the Pancreas", "Pancreatic Neuroendocrine Neoplasms (PanNENs)");
  s.addText("For Medical Students  |  Comprehensive Review", {
    x: 0.5, y: 3.2, w: 9, h: 0.4, fontSize: 13, color: C.midGray,
    align: "center", fontFace: "Calibri"
  });
  s.addText("Sources: Robbins & Cotran Pathology · Bailey & Love Surgery · Harrison's Principles · Yamada's Gastroenterology", {
    x: 0.5, y: 4.9, w: 9, h: 0.4, fontSize: 9, color: C.midGray,
    align: "center", fontFace: "Calibri", italic: true
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 2 – OUTLINE
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide(C.lightGray);
  slideHeading(s, "Lecture Outline");
  const topics = [
    ["1. Introduction & Classification", C.navy],
    ["2. Pathogenesis & Molecular Genetics", C.teal],
    ["3. WHO Grading System", C.teal],
    ["4. Insulinoma", C.navy],
    ["5. Gastrinoma & Zollinger-Ellison Syndrome", C.navy],
    ["6. Glucagonoma", C.teal],
    ["7. VIPoma (Verner-Morrison Syndrome)", C.teal],
    ["8. Somatostatinoma & Rare Tumours", C.teal],
    ["9. Non-Functioning PanNETs", C.navy],
    ["10. MEN-1 Association", C.navy],
    ["11. Imaging & Diagnosis", C.teal],
    ["12. Management Principles", C.navy],
    ["13. Prognosis & Summary", C.teal],
  ];
  const col1 = topics.slice(0, 7);
  const col2 = topics.slice(7);
  col1.forEach((t, i) => {
    s.addShape(pres.ShapeType.roundRect, { x: 0.4, y: 1.1 + i * 0.58, w: 4.5, h: 0.46, fill: { color: t[1] }, rectRadius: 0.07 });
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  col2.forEach((t, i) => {
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  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 3 – INTRODUCTION
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide();
  slideHeading(s, "Introduction");
  sectionTitle(s, "WHAT ARE PanNENs?");
  addBullets(s, [
    bullet("Preferred term: Pancreatic Neuroendocrine Neoplasms (PanNENs)"),
    bullet("Also called: islet cell tumours, P-NETs"),
    bullet("Rare – account for only ~2% of all pancreatic neoplasms"),
    bullet("Arise from islet cells of Langerhans (endocrine pancreas)"),
    bullet("Can occur anywhere in the pancreas or adjacent peripancreatic tissues"),
    bullet("May be single or multiple"),
    bullet("Functional (hormone-secreting) OR Non-functional", false),
    bullet("Non-functional tumours = 25–100% of all P-NETs; diagnosed later due to lack of symptoms", 1),
    bullet("When malignant → liver is the most common site of metastases"),
  ], 0.4, 1.05, 9.2, 4.2);
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 4 – ISLETS OF LANGERHANS (PHYSIOLOGY)
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide(C.lightGray);
  slideHeading(s, "The Endocrine Pancreas – Islets of Langerhans");
  // Central circle label
  s.addShape(pres.ShapeType.ellipse, { x: 3.8, y: 1.8, w: 2.4, h: 2.1, fill: { color: C.paleBlue }, line: { color: C.teal, width: 2 } });
  s.addText("Islet of\nLangerhans\n~1 million in adult\nCombined wt: 1–1.5 g", {
    x: 3.8, y: 1.8, w: 2.4, h: 2.1, fontSize: 11, align: "center", valign: "middle", bold: true, color: C.navy, fontFace: "Calibri"
  });
  // Cell boxes
  const cells = [
    { label: "β Cells\n65–80%", sub: "Secrete: Insulin", x: 0.3, y: 1.5, color: C.navy },
    { label: "α Cells\n15–20%", sub: "Secrete: Glucagon", x: 0.3, y: 3.3, color: C.teal },
    { label: "δ Cells\n3–10%", sub: "Secrete: Somatostatin", x: 7.3, y: 1.5, color: C.green },
    { label: "PP Cells\n~1%", sub: "Secrete: Pancreatic Polypeptide", x: 7.3, y: 3.3, color: C.amber + "" },
  ];
  cells.forEach(c => {
    s.addShape(pres.ShapeType.roundRect, { x: c.x, y: c.y, w: 2.6, h: 1.4, fill: { color: c.color }, rectRadius: 0.1 });
    s.addText([
      { text: c.label + "\n", options: { fontSize: 14, bold: true, breakLine: false } },
      { text: c.sub, options: { fontSize: 11, bold: false } }
    ], { x: c.x, y: c.y, w: 2.6, h: 1.4, align: "center", valign: "middle", color: C.white, fontFace: "Calibri" });
  });
  s.addText("Endocrine cells constitute approximately 1–2% of the total pancreatic mass", {
    x: 0.5, y: 5.0, w: 9, h: 0.4, fontSize: 11, italic: true, color: C.teal, align: "center", fontFace: "Calibri"
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 5 – CLASSIFICATION TABLE
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide();
  slideHeading(s, "Classification of PanNENs");
  sectionTitle(s, "FUNCTIONAL vs NON-FUNCTIONAL");

  const rows = [
    ["Tumour Type", "Cell of Origin", "Hormone", "Malignancy Rate", "Key Syndrome"],
    ["Insulinoma", "β cell", "Insulin", "~10%", "Hypoglycaemia"],
    ["Gastrinoma", "G cell / δ cell", "Gastrin", ">50–60%", "Zollinger-Ellison"],
    ["Glucagonoma", "α cell", "Glucagon", "~60–80%", "Necrolytic migratory erythema"],
    ["VIPoma", "Non-β islet cell", "VIP", "~60–80%", "Verner-Morrison (WDHA)"],
    ["Somatostatinoma", "δ cell", "Somatostatin", "~60–70%", "Diabetes, steatorrhoea, cholelithiasis"],
    ["Non-Functional", "Various", "None*", "~60–90%", "Mass effect (pain, jaundice)"],
  ];
  const colW = [1.5, 1.5, 1.3, 1.4, 3.5];
  const rowH = 0.52;
  const startX = 0.2, startY = 1.05;

  rows.forEach((row, ri) => {
    row.forEach((cell, ci) => {
      const xPos = startX + colW.slice(0, ci).reduce((a, b) => a + b, 0);
      const yPos = startY + ri * rowH;
      const bg = ri === 0 ? C.navy : (ri % 2 === 0 ? C.paleBlue : C.white);
      const fg = ri === 0 ? C.white : C.textDark;
      s.addShape(pres.ShapeType.rect, { x: xPos, y: yPos, w: colW[ci], h: rowH, fill: { color: bg }, line: { color: C.midGray, width: 0.5 } });
      s.addText(cell, { x: xPos, y: yPos, w: colW[ci], h: rowH, fontSize: ri === 0 ? 11 : 10.5, bold: ri === 0, color: fg, align: "center", valign: "middle", fontFace: "Calibri" });
    });
  });
  s.addText("*May produce hormones subclinically; diagnosed by mass effect or incidentally", {
    x: 0.3, y: 5.15, w: 9.5, h: 0.3, fontSize: 9, italic: true, color: C.midGray, fontFace: "Calibri"
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 6 – PATHOGENESIS & MOLECULAR GENETICS
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide(C.navy);
  slideHeading(s, "Pathogenesis & Molecular Genetics");
  s.background = { color: C.navy };
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 1, fill: { color: "0A1E3A" } });
  s.addText("Pathogenesis & Molecular Genetics", {
    x: 0.4, y: 0.1, w: 9.2, h: 0.8, fontSize: 22, bold: true, color: C.white, fontFace: "Calibri", valign: "middle"
  });

  const boxes = [
    { title: "MEN1 Mutation", body: "Mutated in familial MEN-1 syndrome AND sporadic PanNENs\nTumour suppressor on chromosome 11q13", color: C.teal, x: 0.3, y: 1.15 },
    { title: "PTEN / TSC2 Loss", body: "Loss-of-function mutations activate the mTOR signalling pathway\n→ Oncogenic proliferation", color: C.green, x: 3.55, y: 1.15 },
    { title: "ATRX / DAXX Mutations", body: "Inactivating mutations in ~50% of PanNENs\nLead to Alternative Lengthening of Telomeres (ALT)\n→ Telomere maintenance without telomerase", color: C.amber, x: 6.8, y: 1.15 },
  ];
  boxes.forEach(b => {
    s.addShape(pres.ShapeType.roundRect, { x: b.x, y: b.y, w: 3.1, h: 2.0, fill: { color: b.color }, rectRadius: 0.12 });
    s.addText(b.title, { x: b.x + 0.1, y: b.y + 0.08, w: 2.9, h: 0.42, fontSize: 14, bold: true, color: C.white, fontFace: "Calibri" });
    s.addText(b.body, { x: b.x + 0.1, y: b.y + 0.52, w: 2.9, h: 1.4, fontSize: 12, color: C.white, fontFace: "Calibri", valign: "top" });
  });

  addBullets(s, [
    bullet("Sporadic PanNEN genome sequencing has identified 3 major recurrent alterations", false),
    bullet("MEN1 mutations also found in ~40% of sporadic tumours (not just familial)", 1),
    bullet("mTOR pathway activation is therapeutically relevant – target of everolimus", 1),
    bullet("ATRX and DAXX are mutually exclusive (operate in the same pathway)", 1),
    bullet("Common clinical syndromes: (1) Hyperinsulinism  (2) Hypergastrinemia / ZES  (3) MEN-1 associated", false),
  ], 0.3, 3.25, 9.4, 2.1);
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 7 – WHO GRADING
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide(C.lightGray);
  slideHeading(s, "WHO Grading of PanNENs (2022)");
  sectionTitle(s, "GRADING BASED ON PROLIFERATIVE INDEX");

  const grades = [
    { grade: "Grade 1 NET\n(Well Differentiated)", mitoses: "<2 / 10 HPF", ki67: "<3%", behavior: "Low malignant potential", color: C.green },
    { grade: "Grade 2 NET\n(Well Differentiated)", mitoses: "2–20 / 10 HPF", ki67: "3–20%", behavior: "Intermediate malignant potential", color: C.amber },
    { grade: "Grade 3 NET\n(Well Differentiated, high proliferative index)", mitoses: ">20 / 10 HPF", ki67: ">20%", behavior: "High malignant potential", color: C.red },
    { grade: "NEC\n(Neuroendocrine Carcinoma – Poorly Differentiated)", mitoses: ">20 / 10 HPF", ki67: ">20%", behavior: "Small cell or large cell type – aggressive", color: "5D0000" },
  ];
  const headers = ["Grade / Type", "Mitoses / 10 HPF", "Ki-67 Index", "Behavior"];
  const hW = [2.9, 1.8, 1.5, 3.3];
  const sx = 0.25, sy = 1.05;
  // Header
  headers.forEach((h, i) => {
    const xPos = sx + hW.slice(0, i).reduce((a, b) => a + b, 0);
    s.addShape(pres.ShapeType.rect, { x: xPos, y: sy, w: hW[i], h: 0.48, fill: { color: C.navy }, line: { color: C.white, width: 0.5 } });
    s.addText(h, { x: xPos, y: sy, w: hW[i], h: 0.48, fontSize: 12, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
  });
  grades.forEach((g, ri) => {
    const rowData = [g.grade, g.mitoses, g.ki67, g.behavior];
    rowData.forEach((cell, ci) => {
      const xPos = sx + hW.slice(0, ci).reduce((a, b) => a + b, 0);
      const yPos = sy + 0.48 + ri * 0.88;
      const bg = ci === 0 ? g.color : (ri % 2 === 0 ? C.white : C.paleBlue);
      s.addShape(pres.ShapeType.rect, { x: xPos, y: yPos, w: hW[ci], h: 0.88, fill: { color: bg }, line: { color: C.midGray, width: 0.5 } });
      s.addText(cell, { x: xPos, y: yPos, w: hW[ci], h: 0.88, fontSize: ci === 0 ? 11 : 12, bold: ci === 0, color: ci === 0 ? C.white : C.textDark, align: "center", valign: "middle", fontFace: "Calibri" });
    });
  });
  s.addText("HPF = High-Power Field  |  NEC = Neuroendocrine Carcinoma  |  NET = Neuroendocrine Tumour", {
    x: 0.3, y: 5.2, w: 9.5, h: 0.28, fontSize: 9, italic: true, color: C.midGray, fontFace: "Calibri"
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 8 – INSULINOMA OVERVIEW
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide();
  slideHeading(s, "Insulinoma");
  sectionTitle(s, "MOST COMMON FUNCTIONAL PanNET");

  const facts = [
    { icon: "β-Cell", label: "Cell of Origin", val: "Pancreatic β cells (insulin-producing)" },
    { icon: "~4/M", label: "Incidence", val: "~4 per million per year (1–32 range)" },
    { icon: ">90%", label: "Benign", val: "More than 90% are benign and solitary" },
    { icon: "<2cm", label: "Tumour Size", val: "Usually < 2 cm; equally distributed in pancreas" },
    { icon: "~10%", label: "MEN-1 Assoc.", val: "~10% associated with MEN-1 syndrome" },
  ];
  facts.forEach((f, i) => {
    const row = Math.floor(i / 3), col = i % 3;
    const x = 0.3 + col * 3.15, y = 1.1 + row * 1.8;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 2.9, h: 1.55, fill: { color: C.navy }, rectRadius: 0.1 });
    s.addText(f.icon, { x, y: y + 0.08, w: 2.9, h: 0.55, fontSize: 20, bold: true, color: C.gold, align: "center", fontFace: "Calibri" });
    s.addText(f.label, { x, y: y + 0.58, w: 2.9, h: 0.3, fontSize: 10, color: C.midGray, align: "center", fontFace: "Calibri" });
    s.addText(f.val, { x, y: y + 0.88, w: 2.9, h: 0.6, fontSize: 10.5, color: C.white, align: "center", valign: "top", fontFace: "Calibri" });
  });
  s.addText("Morphology: Solitary pale/red-brown nodule; histologically resembles giant islets; amyloid deposition is a hallmark", {
    x: 0.3, y: 4.85, w: 9.4, h: 0.55, fontSize: 12, color: C.teal, italic: true, fontFace: "Calibri", align: "center"
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 9 – INSULINOMA CLINICAL FEATURES & DIAGNOSIS
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide(C.lightGray);
  slideHeading(s, "Insulinoma – Clinical Features & Diagnosis");

  // Left column – Whipple's Triad box
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.1, w: 4.3, h: 3.8, fill: { color: C.navy }, rectRadius: 0.12 });
  s.addText("WHIPPLE'S TRIAD", { x: 0.3, y: 1.2, w: 4.3, h: 0.5, fontSize: 15, bold: true, color: C.gold, align: "center", fontFace: "Calibri" });
  s.addText([
    { text: "① Symptoms induced by fasting / exercise\n", options: { breakLine: false } },
    { text: "\n② Hypoglycaemia at time of symptoms\n   (plasma glucose < 3.0 mmol/L)\n", options: { breakLine: false } },
    { text: "\n③ Relief of symptoms by glucose\n   administration", options: { breakLine: false } },
  ], { x: 0.45, y: 1.75, w: 4.0, h: 2.9, fontSize: 13, color: C.white, fontFace: "Calibri", valign: "top" });

  // Right column
  addBullets(s, [
    bullet("Clinical Presentation", false),
    bullet("Neuroglycopenic: confusion, stupor, loss of consciousness, coma", 1),
    bullet("Adrenergic: sweating, weakness, hunger, tremor, nausea, anxiety, palpitations", 1),
    bullet("Weight gain (patients learn to eat to survive)", 1),
    bullet("Often misdiagnosed as epilepsy or psychiatric illness", 1),
    bullet("Diagnostic Tests", false),
    bullet("72-hour supervised fast: documented endogenous hyperinsulinism", 1),
    bullet("Elevated C-peptide → confirms endogenous insulin (rules out exogenous)", 1),
    bullet("Elevated proinsulin levels", 1),
    bullet("If fast negative → prolonged oral glucose tolerance test", 1),
  ], 4.9, 1.05, 4.8, 4.0);
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 10 – INSULINOMA IMAGING & TREATMENT
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide();
  slideHeading(s, "Insulinoma – Imaging & Treatment");
  sectionTitle(s, "LOCALISATION AND SURGICAL MANAGEMENT");

  addBullets(s, [
    bullet("Localisation (in order of preference)", false),
    bullet("CT or MRI – first-line; may miss tumours < 1 cm", 1),
    bullet("Endoscopic Ultrasound (EUS) – sensitivity > 90%; best for small tumours", 1),
    bullet("Visceral angiography + arterial stimulation venous sampling – for elusive/multiple lesions", 1),
    bullet("GLP-1 receptor scintigraphy – promising (insulinomas overexpress GLP-1R) but not universally available", 1),
    bullet("Insulinomas are less avid on somatostatin scintigraphy (Octreoscan) – unlike other PanNETs", 1),
    bullet("Treatment", false),
    bullet("SURGERY is the definitive treatment – curative in >90% of benign cases", 1),
    bullet("Exophytic / peripheral tumours → Enucleation (preferred)", 1),
    bullet("Head of pancreas → Pancreatoduodenectomy (Whipple)", 1),
    bullet("Body/tail → Distal pancreatectomy ± spleen preservation", 1),
    bullet("Medical (pre-operative / inoperable):", 1),
    bullet("Diazoxide – inhibits insulin release", 1),
    bullet("Everolimus – mTOR inhibitor; improves glycaemia + antitumour effect", 1),
    bullet("Caution with somatostatin analogues – may suppress counterregulatory hormones → worsen hypoglycaemia", 1),
  ], 0.4, 1.05, 9.2, 4.2);
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 11 – GASTRINOMA OVERVIEW
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide(C.navy);
  s.background = { color: C.navy };
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 1, fill: { color: "0A1E3A" } });
  s.addText("Gastrinoma & Zollinger-Ellison Syndrome", {
    x: 0.4, y: 0.1, w: 9.2, h: 0.8, fontSize: 22, bold: true, color: C.white, fontFace: "Calibri", valign: "middle"
  });

  // Stats boxes
  const stats = [
    { val: "0.5–4\nper million", label: "Incidence" },
    { val: ">50%", label: "Already metastasised\nat diagnosis" },
    { val: "25%", label: "Associated\nwith MEN-1" },
    { val: "90%", label: "Occur in\nGastrinoma Triangle" },
  ];
  stats.forEach((st, i) => {
    colorBox(s, 0.3 + i * 2.4, 1.1, 2.1, 1.5, C.teal, "", C.white);
    s.addText(st.val, { x: 0.3 + i * 2.4, y: 1.1, w: 2.1, h: 0.9, fontSize: 20, bold: true, color: C.gold, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(st.label, { x: 0.3 + i * 2.4, y: 1.95, w: 2.1, h: 0.65, fontSize: 11, color: C.white, align: "center", valign: "top", fontFace: "Calibri" });
  });

  addBullets(s, [
    bullet("Gastrinoma Triangle (90% of tumours): bounded by:", false),
    bullet("Medially: junction of neck and body of pancreas", 1),
    bullet("Inferiorly: junction of 2nd and 3rd parts of duodenum", 1),
    bullet("Superiorly: junction of cystic and common bile ducts", 1),
    bullet("Sporadic: mostly duodenal (60–80%), small (<5 mm), multiple", false),
    bullet("MEN-1: all tumours in duodenum; multiple; generally smaller", false),
    bullet("Histologically bland – rarely shows marked anaplasia", false),
  ], 0.3, 2.75, 9.4, 2.6);
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 12 – GASTRINOMA / ZES CLINICAL & DIAGNOSIS
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide(C.lightGray);
  slideHeading(s, "Gastrinoma – Clinical Features & Diagnosis");

  // ZES feature boxes
  const features = [
    { h: "Peptic Ulcer Disease", b: "Present in >90% of patients\nOften multiple, in unusual locations\nIntractable jejunal ulcers → suspect ZES", c: C.red },
    { h: "Diarrhoea", b: "Present in >50% of patients\nPresenting symptom in ~30%\nCaused by massive gastric acid hypersecretion", c: C.teal },
    { h: "GERD / Reflux", b: "Abdominal pain in >75% of patients\nGER most common symptom\nMay mimic simple reflux disease", c: C.navy },
  ];
  features.forEach((f, i) => {
    s.addShape(pres.ShapeType.roundRect, { x: 0.25 + i * 3.25, y: 1.1, w: 3.0, h: 2.0, fill: { color: f.c }, rectRadius: 0.1 });
    s.addText(f.h, { x: 0.25 + i * 3.25, y: 1.15, w: 3.0, h: 0.48, fontSize: 13, bold: true, color: C.gold, align: "center", fontFace: "Calibri" });
    s.addText(f.b, { x: 0.35 + i * 3.25, y: 1.65, w: 2.8, h: 1.35, fontSize: 11.5, color: C.white, fontFace: "Calibri", valign: "top" });
  });

  addBullets(s, [
    bullet("Diagnosis of ZES", false),
    bullet("Cornerstone: Elevated fasting serum gastrin (FSG)", 1),
    bullet("If FSG raised → measure gastric pH; pH < 2 + FSG > 10× normal = diagnosis confirmed", 1),
    bullet("If FSG < 10× elevated → perform secretin provocation test", 1),
    bullet("Pitfall: PPIs cause false elevation of gastrin – must be stopped before testing", 1),
    bullet("Imaging: CT, MRI, EUS, Octreotide scintigraphy", 1),
  ], 0.3, 3.2, 9.4, 2.15);
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 13 – GASTRINOMA TREATMENT
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide();
  slideHeading(s, "Gastrinoma – Management");
  sectionTitle(s, "MEDICAL + SURGICAL APPROACH");

  // Two-column layout
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.1, w: 4.3, h: 4.2, fill: { color: C.paleBlue }, rectRadius: 0.1 });
  s.addText("MEDICAL MANAGEMENT", { x: 0.3, y: 1.15, w: 4.3, h: 0.45, fontSize: 13, bold: true, color: C.navy, align: "center", fontFace: "Calibri" });
  addBullets(s, [
    bullet("Proton Pump Inhibitors (PPIs)"),
    bullet("First-line for symptom control", 1),
    bullet("Rapid resolution of pain and diarrhoea", 1),
    bullet("Somatostatin Analogues"),
    bullet("Octreotide / lanreotide for refractory cases", 1),
    bullet("Control hypergastrinemia", 1),
    bullet("Everolimus / Sunitinib"),
    bullet("For metastatic / unresectable disease", 1),
  ], 0.45, 1.65, 4.0, 3.45);

  s.addShape(pres.ShapeType.roundRect, { x: 4.9, y: 1.1, w: 4.8, h: 4.2, fill: { color: C.navy }, rectRadius: 0.1 });
  s.addText("SURGICAL MANAGEMENT", { x: 4.9, y: 1.15, w: 4.8, h: 0.45, fontSize: 13, bold: true, color: C.gold, align: "center", fontFace: "Calibri" });
  addBullets(s, [
    { text: "Recommended for sporadic gastrinomas once symptoms controlled", options: { bullet: { indent: 12 }, fontSize: 13, color: C.white, breakLine: true, paraSpaceAfter: 5 } },
    { text: "Eliminates source of gastrin hypersecretion", options: { bullet: { indent: 12 }, fontSize: 13, color: C.white, breakLine: true, paraSpaceAfter: 5 } },
    { text: "Reduces risk of metastatic disease", options: { bullet: { indent: 12 }, fontSize: 13, color: C.white, breakLine: true, paraSpaceAfter: 5 } },
    { text: "MEN-1: generally surgery for tumours ≥1.5–2 cm (controversial for smaller)", options: { bullet: { indent: 12 }, fontSize: 13, color: C.white, breakLine: true, paraSpaceAfter: 5 } },
    { text: "Prognosis: 5-yr survival 65%, 10-yr 51%; complete resection → 90–100% 5/10-yr survival", options: { bullet: { indent: 12 }, fontSize: 13, color: C.gold, breakLine: true, paraSpaceAfter: 5 } },
  ], 5.05, 1.65, 4.5, 3.45);
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 14 – GLUCAGONOMA
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide(C.lightGray);
  slideHeading(s, "Glucagonoma");
  sectionTitle(s, "α-CELL TUMOUR");

  // Hallmark rash callout
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.1, w: 4.5, h: 2.8, fill: { color: C.red }, rectRadius: 0.12 });
  s.addText("NECROLYTIC\nMIGRATORY\nERYTHEMA", { x: 0.3, y: 1.2, w: 4.5, h: 1.1, fontSize: 20, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
  s.addText("Hallmark skin rash\n• Intertriginous sites (groin, buttock)\n• Waxes and wanes\n• Blistering, erosive, crusting lesions", { x: 0.4, y: 2.3, w: 4.2, h: 1.5, fontSize: 12, color: C.white, fontFace: "Calibri", valign: "top" });

  addBullets(s, [
    bullet("Clinical Features – 'The 4 D's of Glucagonoma'", false),
    bullet("Dermatitis – necrolytic migratory erythema (pathognomonic)", 1),
    bullet("Diabetes (glucose intolerance) – due to glucagon excess", 1),
    bullet("Deep vein thrombosis – hypercoagulable state", 1),
    bullet("Depression / weight loss", 1),
    bullet("Other features: anaemia, glossitis, stomatitis", false),
    bullet("Diagnosis", false),
    bullet("Elevated fasting plasma glucagon levels (>500 pg/mL is diagnostic)", 1),
    bullet("CT/MRI for localisation; usually large at presentation", 1),
    bullet("Malignancy rate: 60–80% – often metastasised at diagnosis", 1),
    bullet("Treatment: Somatostatin analogues for symptom control; surgery if resectable", false),
  ], 5.1, 1.05, 4.7, 4.3);
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 15 – VIPoma
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide();
  slideHeading(s, "VIPoma (Verner-Morrison Syndrome)");
  sectionTitle(s, "WDHA SYNDROME");

  // WDHA acronym
  const wdha = [
    { l: "W", t: "Watery", d: "Profuse secretory diarrhoea\n(> 3 litres/day)", c: C.navy },
    { l: "D", t: "Diarrhoea", d: "Electrolyte loss, dehydration,\nmetabolic derangement", c: C.teal },
    { l: "H", t: "Hypokalaemia", d: "Due to massive GI potassium losses\n→ weakness, arrhythmias", c: C.green },
    { l: "A", t: "Achlorhydria", d: "VIP inhibits gastric acid secretion\n→ absence of gastric acid", c: C.amber },
  ];
  wdha.forEach((w, i) => {
    s.addShape(pres.ShapeType.roundRect, { x: 0.3 + i * 2.35, y: 1.05, w: 2.1, h: 2.4, fill: { color: w.c }, rectRadius: 0.12 });
    s.addText(w.l, { x: 0.3 + i * 2.35, y: 1.1, w: 2.1, h: 0.85, fontSize: 40, bold: true, color: C.white, align: "center", fontFace: "Calibri" });
    s.addText(w.t, { x: 0.3 + i * 2.35, y: 1.88, w: 2.1, h: 0.3, fontSize: 12, bold: true, color: C.gold, align: "center", fontFace: "Calibri" });
    s.addText(w.d, { x: 0.3 + i * 2.35, y: 2.2, w: 2.1, h: 1.2, fontSize: 10.5, color: C.white, align: "center", valign: "top", fontFace: "Calibri" });
  });

  addBullets(s, [
    bullet("Pathophysiology: VIP causes massive intestinal fluid / electrolyte secretion"),
    bullet("Tumour: Non-β islet cell; malignancy rate ~60–80%"),
    bullet("Diagnosis: Elevated fasting plasma VIP levels; CT/MRI for localisation"),
    bullet("Stool electrolyte analysis confirms secretory diarrhoea (osmotic gap = 0)"),
    bullet("Treatment"),
    bullet("Somatostatin analogues (octreotide / lanreotide) – first-line for WDHA control", 1),
    bullet("IV fluids and electrolyte replacement – critical acute management", 1),
    bullet("Surgical resection for localised disease", 1),
  ], 0.3, 3.6, 9.4, 1.75);
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 16 – SOMATOSTATINOMA & RARE TUMOURS
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide(C.lightGray);
  slideHeading(s, "Somatostatinoma & Other Rare Functional Tumours");

  // Somatostatinoma triad
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.1, w: 4.6, h: 3.8, fill: { color: C.navy }, rectRadius: 0.12 });
  s.addText("SOMATOSTATINOMA", { x: 0.3, y: 1.15, w: 4.6, h: 0.45, fontSize: 14, bold: true, color: C.gold, align: "center", fontFace: "Calibri" });
  s.addText("Inhibitory triad:", { x: 0.5, y: 1.65, w: 4.2, h: 0.35, fontSize: 12, bold: true, color: C.amber, fontFace: "Calibri" });
  addBullets(s, [
    { text: "Diabetes mellitus (insulin inhibition)", options: { bullet: { indent: 12 }, fontSize: 12, color: C.white, breakLine: true, paraSpaceAfter: 4 } },
    { text: "Steatorrhoea (pancreatic enzyme inhibition)", options: { bullet: { indent: 12 }, fontSize: 12, color: C.white, breakLine: true, paraSpaceAfter: 4 } },
    { text: "Cholelithiasis (gallbladder motility inhibition)", options: { bullet: { indent: 12 }, fontSize: 12, color: C.white, breakLine: true, paraSpaceAfter: 4 } },
    { text: "δ-cell tumour; ~60–70% malignant", options: { bullet: { indent: 12 }, fontSize: 12, color: C.gold, breakLine: true, paraSpaceAfter: 4 } },
    { text: "Mostly pancreatic head / duodenum", options: { bullet: { indent: 12 }, fontSize: 12, color: C.white, breakLine: true, paraSpaceAfter: 4 } },
    { text: "Associated with NF-1 (neurofibromatosis)", options: { bullet: { indent: 12 }, fontSize: 12, color: C.white, breakLine: true, paraSpaceAfter: 4 } },
  ], 0.4, 2.05, 4.3, 2.7);

  // Rare tumours column
  s.addShape(pres.ShapeType.roundRect, { x: 5.2, y: 1.1, w: 4.5, h: 3.8, fill: { color: C.lightGray }, rectRadius: 0.12, line: { color: C.teal, width: 1.5 } });
  s.addText("OTHER RARE FUNCTIONAL TUMOURS", { x: 5.2, y: 1.15, w: 4.5, h: 0.45, fontSize: 12, bold: true, color: C.teal, align: "center", fontFace: "Calibri" });
  const rare = [
    { t: "GRFoma", d: "Growth hormone releasing factor → acromegaly" },
    { t: "ACTHoma", d: "ACTH secretion → Cushing's syndrome (Rx: ketoconazole, metyrapone)" },
    { t: "PPoma", d: "Pancreatic polypeptide – usually non-functional" },
    { t: "Carcinoid", d: "Serotonin-releasing → carcinoid syndrome (flushing, diarrhoea)" },
    { t: "PTH-related", d: "Ectopic PTH secretion → hypercalcaemia" },
  ];
  rare.forEach((r, i) => {
    s.addText(r.t + ":", { x: 5.4, y: 1.7 + i * 0.6, w: 1.3, h: 0.5, fontSize: 12, bold: true, color: C.navy, fontFace: "Calibri", valign: "top" });
    s.addText(r.d, { x: 6.7, y: 1.7 + i * 0.6, w: 2.8, h: 0.5, fontSize: 11, color: C.textDark, fontFace: "Calibri", valign: "top" });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 17 – NON-FUNCTIONING PanNETs
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide();
  slideHeading(s, "Non-Functioning PanNETs");
  sectionTitle(s, "LARGEST SUBGROUP – DIAGNOSED LATE");

  addBullets(s, [
    bullet("Definition: No clinically apparent hormonal hypersecretion syndrome"),
    bullet("May produce hormones subclinically (e.g. pancreatic polypeptide, chromogranin A)"),
    bullet("Account for 25–100% of all P-NETs depending on series"),
    bullet("Why diagnosed late?"),
    bullet("No hormonal symptoms → come to attention only via mass effect or incidentally", 1),
    bullet("Symptoms: abdominal pain, jaundice (biliary obstruction), weight loss, GI bleeding", 1),
    bullet("Often larger at presentation than functional tumours", 1),
    bullet("Malignancy: ~60–90% are malignant at diagnosis"),
    bullet("Liver metastases are the most common site of spread"),
    bullet("Diagnosis"),
    bullet("CT/MRI – typically large, well-defined, enhancing lesions on contrast imaging", 1),
    bullet("Somatostatin receptor scintigraphy (Octreoscan) / DOTATATE PET-CT – highly sensitive", 1),
    bullet("Serum markers: Chromogranin A (CgA), NSE, pancreatic polypeptide", 1),
    bullet("EUS-guided biopsy for tissue diagnosis and grading", 1),
    bullet("Treatment: Surgery (if resectable); SSAs for antiproliferative effect; everolimus/sunitinib for advanced disease"),
  ], 0.4, 1.05, 9.2, 4.3);
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 18 – MEN-1 ASSOCIATION
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide(C.navy);
  s.background = { color: C.navy };
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 1, fill: { color: "0A1E3A" } });
  s.addText("Multiple Endocrine Neoplasia Type 1 (MEN-1) & PanNETs", {
    x: 0.4, y: 0.1, w: 9.2, h: 0.8, fontSize: 21, bold: true, color: C.white, fontFace: "Calibri", valign: "middle"
  });

  // MEN-1 triad
  const organs = [
    { label: "Parathyroid\n(>90%)", sub: "Hyperparathyroidism\nHypercalcaemia", c: C.teal },
    { label: "Pituitary\n(30–40%)", sub: "Prolactinoma most common\nAlso GH / ACTH adenomas", c: C.green },
    { label: "Pancreas\n(60–70%)", sub: "Gastrinoma (most common)\nInsulinoma, VIPoma, etc.", c: C.amber },
  ];
  organs.forEach((o, i) => {
    s.addShape(pres.ShapeType.roundRect, { x: 0.5 + i * 3.1, y: 1.15, w: 2.7, h: 2.2, fill: { color: o.c }, rectRadius: 0.12 });
    s.addText(o.label, { x: 0.5 + i * 3.1, y: 1.2, w: 2.7, h: 0.85, fontSize: 16, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(o.sub, { x: 0.6 + i * 3.1, y: 2.05, w: 2.5, h: 1.25, fontSize: 12, color: C.white, fontFace: "Calibri", valign: "top", align: "center" });
  });

  addBullets(s, [
    bullet("MEN-1 gene (chromosome 11q13) encodes Menin – a tumour suppressor", false),
    bullet("Autosomal dominant inheritance with high penetrance", false),
    bullet("Pancreatic manifestations in MEN-1:", false),
    bullet("Gastrinomas most common (multiple, duodenal, small, often malignant)", 1),
    bullet("Insulinomas: ~10% of insulinomas are MEN-1 associated", 1),
    bullet("PanNETs in MEN-1: typically multiple, smaller, duodenal", 1),
    bullet("Surgery role controversial for small tumours (<1.5 cm) – watchful waiting may be preferred", 1),
    bullet("Screening: Annual surveillance with MRI, EUS, biochemical markers in MEN-1 families", false),
  ], 0.3, 3.45, 9.4, 1.95);
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 19 – IMAGING & DIAGNOSIS
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide(C.lightGray);
  slideHeading(s, "Imaging & Diagnostic Workup of PanNETs");
  sectionTitle(s, "LOCALISATION STRATEGY");

  const modalities = [
    { t: "CT Scan\n(Triple Phase)", b: "First-line cross-sectional imaging\nHypervascular tumours enhance on arterial phase\nDetects liver metastases", c: C.navy, x: 0.2, y: 1.1 },
    { t: "MRI", b: "Superior soft tissue contrast\nPreferred for small lesions and liver mets\nHigh sensitivity for insulinomas", c: C.teal, x: 2.6, y: 1.1 },
    { t: "EUS\n(Endoscopic US)", b: "Best for tumours < 1 cm\nSensitivity > 90% for insulinoma\nAllows FNA biopsy for grading", c: C.green, x: 5.0, y: 1.1 },
    { t: "DOTATATE\nPET-CT", b: "Somatostatin receptor imaging\nVery high sensitivity for most PanNETs (except insulinoma)\nDetects occult / metastatic disease", c: C.amber, x: 7.4, y: 1.1 },
  ];
  modalities.forEach(m => {
    s.addShape(pres.ShapeType.roundRect, { x: m.x, y: m.y, w: 2.2, h: 2.7, fill: { color: m.c }, rectRadius: 0.1 });
    s.addText(m.t, { x: m.x, y: m.y + 0.08, w: 2.2, h: 0.65, fontSize: 13, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(m.b, { x: m.x + 0.1, y: m.y + 0.78, w: 2.0, h: 1.85, fontSize: 11, color: C.white, fontFace: "Calibri", valign: "top" });
  });

  addBullets(s, [
    bullet("Biochemical Markers:", false),
    bullet("Chromogranin A (CgA) – general marker; elevated in 70–80%; false positives with PPIs", 1),
    bullet("NSE (Neuron-Specific Enolase) – marker for aggressive/poorly differentiated tumours", 1),
    bullet("Specific hormones: fasting insulin, gastrin, glucagon, VIP, somatostatin", 1),
    bullet("Histology: Synaptophysin and Chromogranin A IHC confirm neuroendocrine origin; Ki-67 for grading", false),
  ], 0.3, 3.9, 9.4, 1.5);
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 20 – MANAGEMENT OVERVIEW
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide();
  slideHeading(s, "Management Principles – PanNETs");
  sectionTitle(s, "MULTIMODAL APPROACH");

  const steps = [
    { n: "1", t: "Control Hormone Excess", b: "PPIs (gastrinoma)\nDiazoxide (insulinoma)\nSSAs: octreotide / lanreotide (glucagonoma, VIPoma)\nEverolimus (insulinoma glycaemia)", c: C.navy },
    { n: "2", t: "Surgical Resection", b: "Curative intent for localised disease\nEnucleation / pancreatectomy\nLaparotomy + intraoperative US if imaging negative", c: C.teal },
    { n: "3", t: "Antiproliferative Therapy", b: "SSAs (octreotide LAR / lanreotide)\nEverolimus (mTOR inhibitor)\nSunitinib (tyrosine kinase inhibitor)", c: C.green },
    { n: "4", t: "Liver-Directed Therapy", b: "Hepatic arterial embolisation\nRFA / microwave ablation\nLiver resection for resectable mets", c: C.amber },
    { n: "5", t: "PRRT", b: "Peptide Receptor Radionuclide Therapy\nLu-177 DOTATATE for SSR-positive metastatic disease\nSignificant PFS benefit (NETTER-1 trial)", c: C.red },
  ];
  steps.forEach((st, i) => {
    const x = 0.25 + (i % 3) * 3.2;
    const y = i < 3 ? 1.1 : 3.15;
    if (i === 3) { /* second row left */ }
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 2.9, h: 1.85, fill: { color: st.c }, rectRadius: 0.1 });
    s.addText(st.n, { x, y: y + 0.05, w: 0.55, h: 0.55, fontSize: 18, bold: true, color: C.gold, fontFace: "Calibri", align: "center" });
    s.addText(st.t, { x: x + 0.45, y: y + 0.05, w: 2.4, h: 0.5, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", valign: "middle" });
    s.addText(st.b, { x: x + 0.1, y: y + 0.6, w: 2.7, h: 1.2, fontSize: 10.5, color: C.white, fontFace: "Calibri", valign: "top" });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 21 – SOMATOSTATIN ANALOGUES
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide(C.lightGray);
  slideHeading(s, "Somatostatin Analogues – Key Pharmacology");
  sectionTitle(s, "CORNERSTONE OF MEDICAL MANAGEMENT");

  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.1, w: 9.4, h: 1.0, fill: { color: C.teal }, rectRadius: 0.1 });
  s.addText("Mechanism: SSAs bind somatostatin receptors (SSTR2/5) on tumour cells → inhibit hormone secretion and tumour proliferation", {
    x: 0.4, y: 1.15, w: 9.2, h: 0.9, fontSize: 13, color: C.white, fontFace: "Calibri", valign: "middle", bold: false
  });

  addBullets(s, [
    bullet("Drugs: Octreotide (short-acting / LAR) · Lanreotide (Autogel / Somatuline)"),
    bullet("Indications in PanNETs:"),
    bullet("Symptom control: gastrinoma, glucagonoma, VIPoma, somatostatinoma, carcinoid syndrome", 1),
    bullet("Antiproliferative: approved for G1/G2 tumours (PROMID, CLARINET trials)", 1),
    bullet("AVOID in insulinoma as monotherapy – may suppress counterregulatory hormones (glucagon, GH)", 1),
    bullet("Side Effects:"),
    bullet("GI: diarrhoea, steatorrhoea, nausea", 1),
    bullet("Cholelithiasis (inhibits gallbladder motility)", 1),
    bullet("Hyperglycaemia (inhibits insulin secretion)", 1),
    bullet("Monitoring: Chromogranin A levels and imaging every 3–6 months on therapy"),
  ], 0.4, 2.2, 9.2, 3.1);
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 22 – PROGNOSIS COMPARISON
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide();
  slideHeading(s, "Prognosis of PanNENs");
  sectionTitle(s, "SURVIVAL DEPENDS ON GRADE, STAGE & TUMOUR TYPE");

  const data = [
    { t: "Insulinoma", mal: "~10%", surv: "Excellent (>90% cured by surgery)", bar: 90, c: C.green },
    { t: "Gastrinoma", mal: ">50%", surv: "5-yr 65%, 10-yr 51%\n(Complete resection → 90-100%)", bar: 65, c: C.amber },
    { t: "Glucagonoma", mal: "60–80%", surv: "Poor – usually metastasised at diagnosis", bar: 40, c: C.red },
    { t: "VIPoma", mal: "60–80%", surv: "Moderate with SSA control", bar: 50, c: C.teal },
    { t: "Non-Functional", mal: "60–90%", surv: "Variable – depends on grade", bar: 55, c: C.navy },
  ];

  s.addText("Tumour", { x: 0.3, y: 1.05, w: 2.2, h: 0.4, fontSize: 12, bold: true, color: C.navy, fontFace: "Calibri" });
  s.addText("Malignancy Rate", { x: 2.6, y: 1.05, w: 1.8, h: 0.4, fontSize: 12, bold: true, color: C.navy, fontFace: "Calibri", align: "center" });
  s.addText("Approximate 5-yr Survival", { x: 4.5, y: 1.05, w: 5.2, h: 0.4, fontSize: 12, bold: true, color: C.navy, fontFace: "Calibri" });

  data.forEach((d, i) => {
    const y = 1.55 + i * 0.82;
    s.addShape(pres.ShapeType.roundRect, { x: 0.3, y, w: 2.1, h: 0.65, fill: { color: d.c }, rectRadius: 0.06 });
    s.addText(d.t, { x: 0.3, y, w: 2.1, h: 0.65, fontSize: 13, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(d.mal, { x: 2.55, y, w: 1.8, h: 0.65, fontSize: 13, color: C.red, align: "center", valign: "middle", fontFace: "Calibri", bold: true });
    // bar
    s.addShape(pres.ShapeType.rect, { x: 4.5, y: y + 0.12, w: 5.0 * d.bar / 100, h: 0.4, fill: { color: d.c } });
    s.addText(d.surv, { x: 4.5, y: y + 0.0, w: 5.0, h: 0.65, fontSize: 10, color: C.textDark, valign: "middle", fontFace: "Calibri" });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 23 – COMPARISON SUMMARY TABLE
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = addSlide(C.lightGray);
  slideHeading(s, "Quick Comparison – Functional PanNETs");

  const rows = [
    ["Feature", "Insulinoma", "Gastrinoma", "Glucagonoma", "VIPoma"],
    ["Hormone", "Insulin", "Gastrin", "Glucagon", "VIP"],
    ["Key Symptom", "Hypoglycaemia\n(Whipple's triad)", "PUD, diarrhoea\n(ZES)", "NME rash\nDiabetes", "WDHA\n(watery diarrhoea)"],
    ["Diagnosis", "72-hr fast\nC-peptide↑", "FSG↑ + pH<2\nSecretin test", "Plasma glucagon\n>500 pg/mL", "Plasma VIP↑\nStool osmol gap"],
    ["Malignancy", "~10% (best prognosis)", "~50–60%", "~60–80%", "~60–80%"],
    ["Treatment", "Surgery\n(enucleation)", "PPI + Surgery", "SSA + Surgery", "IV fluids + SSA"],
    ["MEN-1 Link", "~10%", "~25%", "Rare", "Rare"],
  ];
  const cW = [1.9, 1.85, 1.85, 1.85, 1.85];
  const rH = 0.65;
  const sx = 0.15, sy = 1.05;
  rows.forEach((row, ri) => {
    row.forEach((cell, ci) => {
      const x = sx + cW.slice(0, ci).reduce((a, b) => a + b, 0);
      const y = sy + ri * rH;
      const isH = ri === 0;
      const isFeat = ci === 0;
      const bg = isH ? C.navy : (isFeat ? C.softBlue : (ri % 2 === 0 ? C.white : C.paleBlue));
      s.addShape(pres.ShapeType.rect, { x, y, w: cW[ci], h: rH, fill: { color: bg }, line: { color: C.midGray, width: 0.5 } });
      s.addText(cell, { x, y, w: cW[ci], h: rH, fontSize: isH ? 11 : 10.5, bold: isH || isFeat, color: (isH || isFeat) ? C.white : C.textDark, align: "center", valign: "middle", fontFace: "Calibri" });
    });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 24 – KEY EXAM POINTS
// ─────────────────────────────────────────────────────────────────────────────
{
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  });

  const points = [
    "Most common PanNET = Insulinoma (and most are benign ~90%)",
    "Whipple's triad: symptoms with fasting + hypoglycaemia + relief with glucose",
    "Most common functional malignant PanNET = Gastrinoma",
    "ZES: PUD + diarrhoea + elevated FSG; intractable jejunal ulcers are a red flag",
    "Gastrinoma triangle: 90% of gastrinomas arise within this anatomic zone",
    "Necrolytic migratory erythema (NME) = pathognomonic for glucagonoma",
    "WDHA syndrome (Watery Diarrhoea, Hypokalaemia, Achlorhydria) = VIPoma",
    "Ki-67 index determines grade; >20% = Grade 3 NET or NEC",
    "ATRX / DAXX mutations in ~50% of sporadic PanNENs → ALT mechanism",
    "MEN-1 (11q13): parathyroid + pituitary + pancreas; gastrinoma most common PanNET in MEN-1",
    "Somatostatin analogues = cornerstone of medical management (AVOID monotherapy in insulinoma)",
    "DOTATATE PET-CT is most sensitive for somatostatin receptor-positive PanNETs",
  ];
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  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 25 – SUMMARY MIND MAP / FLOWCHART
// ─────────────────────────────────────────────────────────────────────────────
{
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  slideHeading(s, "Summary – Approach to a Patient with Suspected PanNET");

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    { t: "Biochemical Tests", b: "Fasting glucose, insulin,\ngastrin, glucagon, VIP\nCgA, NSE\n72-hr fast if insulinoma", c: C.teal, x: 3.4, y: 1.1 },
    { t: "Imaging", b: "CT/MRI (triple phase)\nEUS for small lesions\nDOTATATE PET-CT\n(not insulinoma)", c: C.green, x: 6.6, y: 1.1 },
    { t: "Histology & Grade", b: "Synaptophysin / CgA IHC\nKi-67 index (G1/G2/G3)\nDifferentiation status", c: C.amber, x: 0.2, y: 3.5 },
    { t: "Staging & MEN-1 Screen", b: "Liver / lymph node mets\nFamily history\nCalcium, PTH, pituitary MRI", c: C.red, x: 3.4, y: 3.5 },
    { t: "Management", b: "Surgical resection\nMedical: SSA / PPI / diazoxide\nEvero/Sunitinib / PRRT\nLiver-directed Rx", c: C.softBlue, x: 6.6, y: 3.5 },
  ];
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// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 26 – REFERENCES
// ─────────────────────────────────────────────────────────────────────────────
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  const refs = [
    "1. Kumar V, Abbas A, Aster J. Robbins & Cotran Pathologic Basis of Disease. 10th ed. 2023. Ch.19 – Pancreatic Neuroendocrine Neoplasms.",
    "2. Bailey RW, Love M. Bailey and Love's Short Practice of Surgery. 28th ed. 2022. Ch.57 – Pancreatic Neuroendocrine Tumours.",
    "3. Loscalzo J et al. Harrison's Principles of Internal Medicine. 22nd ed. 2025. Ch.89 – Pancreatic NETs.",
    "4. Kumar V, Abbas A, Aster J. Robbins & Kumar Basic Pathology. 11th ed. 2023. Ch.18 – PanNETs.",
    "5. Yamada T et al. Yamada's Textbook of Gastroenterology. 7th ed. 2019. Ch.25 – Pancreatic Neuroendocrine Tumours.",
    "6. WHO Classification of Tumours. Digestive System Tumours. 5th ed. 2019 – Grading criteria for PanNENs.",
    "7. Strosberg J et al. Phase 3 Trial of 177Lu-DOTATATE for Midgut Neuroendocrine Tumors (NETTER-1). NEJM 2017.",
  ];
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      fontFace: "Calibri", valign: "middle"
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// ─────────────────────────────────────────────────────────────────────────────
// WRITE FILE
// ─────────────────────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/endocrine-pancreas-ppt/Endocrine_Tumours_Pancreas.pptx" })
  .then(() => console.log("DONE: Endocrine_Tumours_Pancreas.pptx written successfully"))
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