Vagus nerve shwannoma presented with long-term cachexia: report of a case and review of literature

Intraabdominal schwannomas are rare tumors that may arise from viscera or abdominal wall. The rarity accompanied by occurrence in odds places may make their diagnosis difficult and delayed. We present a case of distal paraesophageal schwannoma with long-term cachexia. A34-year-old man presented with long-lasting vomiting، dysphagia، and progressive cachexia for four years. Multiple paraclinical assessments were normal; subsequently he was referred to psychiatric department and treated for anorexia nervosa for three year without any improvement. Further evaluations showed a mass in diaphragm hiatus in paraesophageal region. Explorative laparotomy revealed a cylindric shaped encapsulated tumor parallel to distal esophagus risen from vagus nerve، which was resected completely. Pathological and immunohistochemical examinations of the tumor revealed a benign plexiform schwannoma. After surgery، the patient was relieved from symptoms and gained weight significantly. It is important to consider physical causes in patients with cachexia who are treated for psychiatric problems and it is necessary to reevaluate these patients specially when there is no response to psychiatric treatments.