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const pptx = new pptxgen();
pptx.layout = 'LAYOUT_WIDE'; // 13.333 x 7.5
pptx.author = 'Orris AI';
pptx.company = 'Academic Seminar';
pptx.subject = 'Pathology of Mediastinitis and Mediastinal Tumors';
pptx.title = 'Pathology of Mediastinitis and Mediastinal Tumors';
pptx.lang = 'en-US';

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// Slide 1: Title
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slide.addText('PATHOLOGY OF MEDIASTINITIS\nAND MEDIASTINAL TUMORS', {
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slide.addText('Based on thoracic surgery textbook material including data sourced from Shields General Thoracic Surgery', {
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// Slide 2: Objectives
slide = pptx.addSlide();
addTitle(slide, 'Learning Objectives');
addBullets(slide, [
  'Define mediastinitis and distinguish acute, descending necrotizing, and chronic fibrosing forms',
  'Review key pathologic mechanisms and routes of spread through cervical-mediastinal fascial planes',
  'Classify mediastinal tumors by compartment and dominant histopathology',
  'Correlate pathology with clinical manifestations, imaging patterns, and diagnostic tissue strategies',
  'Summarize management principles grounded in pathology-driven surgical decision making'
], 0.8, 1.5, 12.0, 5.3, 20);
addFooter(slide, 'Core references: Schwartz\'s Principles of Surgery 11e, Mulholland & Greenfield\'s Surgery 7e');

// Slide 3: Mediastinal anatomy/pathology basis
slide = pptx.addSlide();
addTitle(slide, 'Mediastinum: Pathologic Framework');
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slide.addText('Compartments', { x: 1.1, y: 1.75, w: 2.5, h: 0.4, fontSize: 19, bold: true, color: colors.accent2 });
slide.addText([
  { text: '• Anterior: ', options: { bold: true } }, { text: 'thymic, germ cell, lymphoma, thyroid/parathyroid lesions', options: { breakLine: true } },
  { text: '• Middle: ', options: { bold: true } }, { text: 'foregut cysts, nodal disease, vascular lesions', options: { breakLine: true } },
  { text: '• Posterior: ', options: { bold: true } }, { text: 'neurogenic tumors dominate pathology', options: { breakLine: true } }
], { x: 1.1, y: 2.2, w: 5.4, h: 2.0, fontSize: 15, color: colors.text, lineSpacingMultiple: 1.15 });
slide.addText('Clinical implication: compartment localization narrows differential and guides biopsy approach.', {
  x: 1.1, y: 4.6, w: 5.3, h: 1.4, fontSize: 14, color: colors.muted, italic: true
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slide.addText('Pathology Principles', { x: 7.25, y: 1.75, w: 3.2, h: 0.4, fontSize: 19, bold: true, color: colors.accent });
slide.addText([
  { text: '• Infectious spread follows contiguous fascial planes (neck to mediastinum)', options: { breakLine: true } },
  { text: '• Compressive effects produce airway, vascular, and esophageal syndromes', options: { breakLine: true } },
  { text: '• Histology determines urgency: fulminant sepsis vs indolent fibrotic disease vs neoplasia', options: { breakLine: true } },
  { text: '• Tissue diagnosis is central when non-surgical oncologic therapy is likely', options: { breakLine: true } }
], { x: 7.25, y: 2.2, w: 5.0, h: 3.3, fontSize: 15, color: colors.text, lineSpacingMultiple: 1.15 });
addFooter(slide, 'Source synthesis from major thoracic surgery sections on mediastinal disease');

// Slide 4: Acute mediastinitis pathology
slide = pptx.addSlide();
addTitle(slide, 'Acute Mediastinitis: Pathology and Routes of Infection');
addBullets(slide, [
  'Fulminant mediastinal infection with rapid extension through cervical and mediastinal fascial planes',
  'Most common etiologies: esophageal perforation, deep sternotomy wound infection, and oropharyngeal/neck infection',
  'Other causes include trauma, postoperative leaks, and contiguous spread from deep neck spaces',
  'Typical pathologic progression: necrotizing soft-tissue infection, purulence, tissue edema, systemic inflammatory response',
  'Without immediate source control, progression to florid sepsis, hemodynamic collapse, and death can occur quickly'
], 0.8, 1.45, 12.0, 5.35, 18);
addFooter(slide, 'Schwartz\'s Principles of Surgery 11e, p. 763 (Mediastinitis section)');

// Slide 5: Clinical-pathologic correlation mediastinitis
slide = pptx.addSlide();
addTitle(slide, 'Mediastinitis: Clinical-Pathologic Correlation');
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slide.addText('Key symptom-complex', { x: 1.2, y: 1.9, w: 3.2, h: 0.35, fontSize: 18, bold: true, color: colors.accent2 });
slide.addText('Fever, chest pain, dysphagia, dyspnea, cervical/thoracic crepitus', { x: 1.2, y: 2.3, w: 5.2, h: 0.8, fontSize: 15, color: colors.text });
slide.addText('Imaging-pathology link', { x: 6.8, y: 1.9, w: 3.2, h: 0.35, fontSize: 18, bold: true, color: colors.accent2 });
slide.addText('CT defines extent of mediastinal contamination, gas/fluid collections, pleural extension, and guides drainage approach', { x: 6.8, y: 2.3, w: 5.6, h: 1.2, fontSize: 15, color: colors.text });
slide.addText('Therapeutic pathology principle', { x: 1.2, y: 3.4, w: 4.5, h: 0.35, fontSize: 18, bold: true, color: colors.accent });
slide.addText('Definitive care requires urgent source control and debridement of all involved tissue planes (mediastinum, neck, pleura) plus broad-spectrum antibiotics and resuscitation.', { x: 1.2, y: 3.8, w: 11.0, h: 1.5, fontSize: 15, color: colors.text });
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slide.addText('Acute mediastinitis is a surgical emergency; delay directly worsens survival.', { x: 1.35, y: 5.57, w: 10.8, h: 0.25, fontSize: 13, color: 'FFDDE1', bold: true, align: 'center' });
addFooter(slide, 'Schwartz\'s Principles of Surgery 11e, p. 763; Mulholland & Greenfield\'s Surgery 7e, p. 4385');

// Slide 6: Chronic/fibrosing mediastinitis
slide = pptx.addSlide();
addTitle(slide, 'Chronic and Fibrosing Mediastinitis');
addBullets(slide, [
  'Distinct from acute infection: often indolent fibro-inflammatory process with progressive mediastinal fibrosis',
  'May follow infection or autoimmune-mediated inflammation; can coexist with retroperitoneal fibrosis syndromes',
  'Pathology is dominated by dense collagen deposition and encasement/compression of mediastinal structures',
  'Clinical presentation reflects mass effect: vascular obstruction (eg, SVC syndrome), airway narrowing, esophageal compression',
  'CT is the principal modality for diagnosis and assessing extent; surgery is usually limited to diagnosis or late decompressive intervention'
], 0.8, 1.45, 12.0, 5.3, 17);
addFooter(slide, 'Mulholland & Greenfield\'s Surgery 7e, p. 4385-4386');

// Slide 7: Mediastinal tumor pathology overview
slide = pptx.addSlide();
addTitle(slide, 'Mediastinal Tumors: Pathologic Epidemiology');
slide.addText('Adult Distribution (selected series)', { x: 0.9, y: 1.45, w: 5.8, h: 0.4, fontSize: 18, bold: true, color: colors.accent2 });
slide.addText('• Neurogenic 21%\n• Cysts 20%\n• Thymomas 19%\n• Lymphomas 13%\n• Germ cell tumors 11%\n• Mesenchymal 7%\n• Endocrine 6%', {
  x: 1.1, y: 1.95, w: 5.5, h: 2.8, fontSize: 16, color: colors.text, valign: 'top', breakLine: true
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slide.addText('Pediatric Distribution', { x: 7.0, y: 1.45, w: 5.4, h: 0.4, fontSize: 18, bold: true, color: colors.accent2 });
slide.addText('• Neurogenic 40%\n• Lymphomas 18%\n• Cysts 18%\n• Germ cell tumors 11%\n• Mesenchymal 9%\n• Thymoma rare', {
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slide.addText('Compartment-based pathology remains the central organizing principle for differential diagnosis and operative planning.', {
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addFooter(slide, 'Schwartz\'s Principles of Surgery 11e, p. 756 (Table 19-26; adult data from Shields TW)');

// Slide 8: Major tumor groups by pathology
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addTitle(slide, 'Major Mediastinal Tumor Groups and Histopathology');
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slide.addText('Neurogenic tumors (posterior predominance)', { x: 1.0, y: 1.85, w: 5.6, h: 0.35, fontSize: 15, bold: true, color: colors.accent2 });
slide.addText('• Benign: schwannoma, neurofibroma, ganglioneuroma\n• Malignant: neuroblastoma, ganglioneuroblastoma\n• Pediatric mediastinal neuroblastoma may have more favorable biology than other sites', {
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slide.addText('Anterior mediastinal tumors', { x: 7.25, y: 1.85, w: 5.1, h: 0.35, fontSize: 15, bold: true, color: colors.accent });
slide.addText('• Thymic epithelial tumors\n• Lymphoma (often tissue diagnosis, non-resection first-line)\n• Germ cell tumors (teratoma common; AFP/β-hCG aid classification)', {
  x: 7.25, y: 2.25, w: 5.1, h: 1.9, fontSize: 13.5, color: colors.text
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slide.addText('Cystic lesions and uncommon tumors', { x: 1.0, y: 4.35, w: 5.6, h: 0.35, fontSize: 15, bold: true, color: colors.accent2 });
slide.addText('Foregut duplication and bronchogenic cysts, mesenchymal tumors, endocrine ectopic lesions, and rare sarcomatous entities.', {
  x: 1.0, y: 4.75, w: 11.9, h: 1.0, fontSize: 13.5, color: colors.text
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addFooter(slide, 'Mulholland & Greenfield\'s Surgery 7e, p. 5395-5398; Schwartz\'s Principles of Surgery 11e, p. 756-757');

// Slide 9: Germ cell pathology and markers
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addTitle(slide, 'Mediastinal Germ Cell Tumors: Pathology and Biomarkers');
slide.addBullets;
addBullets(slide, [
  'Teratoma is the most common mediastinal germ cell tumor and typically contains elements from all three germ layers',
  'Mature teratomas are usually benign, cystic, encapsulated, and often calcified; they tend to displace rather than invade',
  'Immature or nonseminomatous tumors carry malignant potential and require multimodal therapy',
  'Serum markers are diagnostically powerful: AFP and β-hCG elevated in most nonseminomatous tumors; AFP remains normal in seminoma',
  'Pathology-directed treatment: resection for mature teratoma; chemotherapy ± radiation plus surgery for malignant elements'
], 0.8, 1.45, 12.0, 5.3, 17);
addFooter(slide, 'Mulholland & Greenfield\'s Surgery 7e, p. 5398; Schwartz\'s Principles of Surgery 11e, p. 756');

// Slide 10: Pathology-driven diagnosis
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addTitle(slide, 'Diagnostic Strategy Guided by Pathology');
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slide.addText('Compartment\nlocalization', { x: 1.15, y: 2.5, w: 1.8, h: 0.6, align: 'center', fontSize: 12, bold: true, color: 'FFFFFF' });
slide.addText('Clinical\nsyndrome', { x: 3.35, y: 2.5, w: 1.8, h: 0.6, align: 'center', fontSize: 12, bold: true, color: 'FFFFFF' });
slide.addText('Cross-sectional\nimaging', { x: 5.55, y: 2.5, w: 1.8, h: 0.6, align: 'center', fontSize: 12, bold: true, color: 'FFFFFF' });
slide.addText('Biomarker\nprofiling', { x: 7.75, y: 2.5, w: 1.8, h: 0.6, align: 'center', fontSize: 12, bold: true, color: '1B1B1B' });
slide.addText('Tissue\ndiagnosis', { x: 10.0, y: 2.5, w: 1.8, h: 0.6, align: 'center', fontSize: 12, bold: true, color: '1B1B1B' });
slide.addText('Minimally invasive sampling is preferred when treatment is expected to be nonsurgical (eg, lymphoma). Combined FNA + core biopsy improves diagnostic yield versus either alone.', {
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addFooter(slide, 'Schwartz\'s Principles of Surgery 11e, p. 757 (mediastinal biopsy strategy and yields)');

// Slide 11: Management by pathology
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addTitle(slide, 'Management Principles by Pathologic Category');
addBullets(slide, [
  'Acute infectious mediastinitis: immediate source control, radical drainage/debridement, broad-spectrum antimicrobial therapy, physiologic support',
  'Chronic fibrosing mediastinitis: symptom-directed management; intervention mainly for diagnosis or severe compressive complications',
  'Benign encapsulated tumors/cysts: complete resection when feasible for cure and prevention of compression/infection',
  'Potentially malignant or malignant neoplasms: multidisciplinary sequencing of biopsy, systemic therapy, and surgery according to histology',
  'Perioperative planning must anticipate airway/vascular compromise in large anterior mediastinal masses'
], 0.8, 1.45, 12.0, 5.3, 17);
addFooter(slide, 'Schwartz\'s Principles of Surgery 11e; Mulholland & Greenfield\'s Surgery 7e');

// Slide 12: Key take-home messages
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addTitle(slide, 'Take-Home Messages');
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  { text: '1) ', options: { bold: true, color: colors.accent2 } }, { text: 'Mediastinitis is a spectrum from rapidly fatal infection to chronic fibro-inflammatory disease.', options: { breakLine: true } },
  { text: '2) ', options: { bold: true, color: colors.accent2 } }, { text: 'Pathologic mechanism determines urgency: septic source control versus selective decompression.', options: { breakLine: true } },
  { text: '3) ', options: { bold: true, color: colors.accent2 } }, { text: 'Mediastinal tumor diagnosis is compartment-driven and confirmed by tissue/biomarker integration.', options: { breakLine: true } },
  { text: '4) ', options: { bold: true, color: colors.accent2 } }, { text: 'Histology dictates treatment sequence and prognosis.', options: { breakLine: true } },
  { text: '5) ', options: { bold: true, color: colors.accent2 } }, { text: 'Surgical judgment is strongest when anchored in pathology.', options: {} }
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addFooter(slide, 'Seminar source base: thoracic surgery textbook chapters with Shields TW-derived mediastinal tumor epidemiology');

// Slide 13: References
slide = pptx.addSlide();
addTitle(slide, 'Selected References');
slide.addText([
  { text: '1. ', options: { bold: true } }, { text: 'Schwartz\'s Principles of Surgery. 11th ed. Mediastinal masses/tumors and mediastinitis sections (pp. 756-757, 763).', options: { breakLine: true } },
  { text: '2. ', options: { bold: true } }, { text: 'Mulholland and Greenfield\'s Surgery: Scientific Principles and Practice. 7th ed. Mediastinitis and mediastinal tumors sections (pp. 4385-4386, 5395-5398).', options: { breakLine: true } },
  { text: '3. ', options: { bold: true } }, { text: 'Data cited in Schwartz table from Shields TW, General Thoracic Surgery (4th ed.) for adult mediastinal tumor distribution.', options: { breakLine: true } },
  { text: '4. ', options: { bold: true } }, { text: 'Additional contextual thoracic surgery references embedded within cited chapters.', options: {} }
], {
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addFooter(slide, 'Prepared for seminar teaching use');

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