Abstract: Objective To analyze the clinical features, diagnosis and treatment of pulmonary blastoma (PB) in adults. Methods Clinical manifestations, pathological characteristics, diagnosis and treatment of 20 PB patients admitted to our hospital from January 1993 to September 2012 were retrospectively analyzed with its relative literature reviewed. Results Of the 20 cases, 17 with their diagnosis not established underwent surgical treatment (15 underwent lobectomy and 2 underwent pneumonectomy) and 3 diagnosed by fineneedle pulmonary aspiration received conservative treatment. Immunohistochemistry showed positive vimentin in 4 biphasic cases, positive AE1/AE3 in 3 cases, positive SMA in 3 cases, and positive CgA in 2 cases. The patients were followed up for an average period of 21 months. The median survival time of the patients was 14.8 months. Conclusion PB is rare in adults with no typical symptoms and is thus difficult to establish its diagnosis before operation. Immunohistochemistry marker can help its differential diagnosis. Surgery is the first choice of treatment. Relapse and metastasis of PB are easy to occur and its prognosis is poor.