This study aims to analyze 30 cases of primary pulmonary lymphoma (PPL) including treatment as well as follow-up information during the past 10 years and to investigate the correlation between microvessel density (MVD) and survival in patients with PPL. We reviewed all patients from October 2000 to October 2010. Patient demographics such as survival, recurrence, time to follow-up, and treatment mode were recorded. We also assessed MVD in the pretreated pulmonary lymphoma tissues of 30 previously untreated patients using α-CD34 immunohistochemical staining. The median age of the 30 patients was 46.9 years. With a median follow-up of 4.3 years (range, 2 to 10 years), the 5-year overall survival (OS) rate was 57 % and progression-free survival (PFS) was 44 %. High MVD, elevated serum lactate dehydrogenase (LDH), and B symptoms was significantly correlated with clinical features and shorter PFS (P(MVD) = 0.021, P(LDH) = 0.023, and P(B symptoms) = 0.005) and OS (P(MVD) = 0.028, P(LDH) = 0.032, and P(B symptoms) = 0.001). Application of surgical treatment improved the PFS (P = 0.024) and OS(P = 0.028) of patients with stage IE disease (patients who were nodal negative). The patient's stage predicted the outcome and guides the use of treatments. Patients with high MVD measured in the microenvironment had worse PFS/OS than those with low MVD expression. Patients who had B symptoms or elevated serum LDH had poor prognosis. Patients with lymph node involvement (stage IIE or greater) had poor prognosis.