Malignant mesothelioma is an aggressive cancer associated with asbestos exposure with median survival time of 8 to 14 months following diagnosis. Given that mesothelial cells also line the peritoneum and pericardium, malignant mesothelioma can present in unusual sites and in patients with nonrespiratory complaints. A 73-year-old male presented to the emergency department for worsening intermittent diffuse abdominal pain for the past 3 months with associated unintentional 40-pound weight loss, early satiety, and diarrhea. He denied exposure to asbestos. Computed tomography imaging revealed multiple masses concerning for malignancy including the primary retroperitoneal mass, a mass involving the terminal ileum, and a mass in the right upper lung. Esophagogastroduodenoscopy demonstrated significant mass effect within the stomach without signs of endoluminal infiltration. Computed tomography–guided biopsy of the retroperitoneal abdominal and intramuscular paraspinal masses was performed. Stage IV epithelioid mesothelioma was confirmed when hematoxylin and eosin staining revealed pleomorphic malignancy nuclei containing a vesicular chromatin pattern and prominent nucleoli and immunohistochemical staining was positive for CK Oscar, cytokeratin 7, GATA3, calretinin, EMA, and CK5/6. He was started on cisplatin, pemetrexed, and bevacizumab but developed severe abdominal pain with pneumoperitoneum and bowel perforation 1 month later and expired shortly thereafter. To our knowledge, this represents a highly atypical presentation of malignant mesothelioma considering the involvement of the retroperitoneum with diffuse lesions in the abdominopelvic cavity and thorax (sparing the lung pleurae). This case also calls attention to the occurrence of malignant mesothelioma in patients without known asbestos exposure and the crucial role of pathology in diagnosing atypical presentations.

Introduction: Obesity related GI disorders can have significant impact on mortality and quality of life. The cornerstone of treatment is lifestyle modifications through diet and exercise, in order to achieve greater than 10 % total body weight loss (TBWL). We have previously shown that in our community-based weight management program 65% of participants achieve .10% TWBL. The program addresses diet, exercise, sleep and mindfulness in order to achieve weight loss. The aim of this study was to assess the impact of a structured weight loss program in patient reported outcomes of physical and mental aspects of health. Methods: The 12-item short-form (SF-12) survey was used to assess physical and mental health. Participants filled out the SF-12 survey at the time of enrollment and after at least 3 months. Patients were placed on a 12-week 800 calorie meal replacement diet (OPTIFAST) then transitioned to a plant predominant or Mediterranean diet. A total of 43 participants from July 2020 to June 2022 were identified who had 2 surveys at least 3 months apart. Surveys were scored using https://orthotoolkit.com/sf-12/. Paired t-tests were preformed on the mental component score (MCS) and physical component score (PCS) pre and post participation. An unpaired t-test was preformed on the change in MCS and PCS in participants who achieved .10% TBWL versus those who did not (Figure). Results: The mean MCS increased from 47.4 to 53.4 (P value50.001009) through participation. The mean PCS increased from 44.7 to 48.6 (P value 50.006272). Of the 43 patients identified, 33 achieved .10% TBWL. The mean difference between the post participation MCS and enrollment MCS in participants who had .10% TBWL was not significantly different than participants who had , 10% TBWL (5.8 vs 6.81, P value50.809). Likewise, the mean difference between the post participation PCS and enrollment PCS in participants who had .10% TBWL was not significantly different than participants who had , 10% TBWL (4.1 vs 2.9, P value50.72). Conclusion: Participation in a weekly support group focused on education about diet, sleep optimization, exercise and teaching mediation techniques was associated with improved SF-12 scores independent of achieving a 10% body weight loss. This suggests that focused education about the 4 pillars of wellness may independently improve SF-12 scores. More research is needed to corroborate these findings.

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