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(A, B) The chest radiograph (A) and contrast-enhanced axial chest CT image with a mediastinal-window setting (B) obtained at our hospital showing a large mass (arrows in A and B) in the left upper lobe. The mass exhibits heterogeneous contrast enhancement with a central low-attenuation area. Note blunting of the left costophrenic angle secondary to left pleural thickening. There is no enlarged mediastinal or hilar lymph node.
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The chest radiograph (Figure 1A) and contrast-enhanced chest CT (Figure 1B) showed a large mass in the left upper lobe.
(A-D) Histopathology revealed (A) Tumor admixed with necrotic tissue (HE stain, 100x), (B) Gram-negative bipolar rods resembling safety pins (Brown-Hopp stain, 1000x), (C) Non-small cell carcinoma favor adenocarcinoma (HE stain, 200x), (D) TTF-1 immunohistochemistry positive nuclear staining (200x).
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Brown-Hopp stain revealed a single cluster of gram-negative bipolar rods with safety pin appearance characteristics of B. pseudomallei. (Figure 2A-D). B. pseudomallei subsequently grew on tissue culture.