Primary lymphoma of the lung is rare and is usually of B cell type. Tissue samplings taken by transbronchial biopsy and computed tomographic (CT) guided needle biopsy of the right perihilar area of an elderly woman who presented with refractory pneumonia showed T cell lymphocytosis with no evidence of active infection. The patient's respiratory status rapidly deteriorated and she eventually died. Post mortem examination revealed primary pulmonary T cell lymphoma with natural killer (NK) cell features. We present what may be the first case of primary NK/T cell pulmonary lymphoma and review the literature on the subject.