Pulmonary cryptococcosis is one of the most common invasive fungal diseases in China, which is easily to be misdiagnosed as a consequence of nonspecific clinical manifestations.Objective: To clarify the clinicopathological, radiological features and treatment of pulmonary cryptococcosis. Further more, investigate the differences between immunocompetent and immunocompromised patients, as well as surgical and non-surgical patients.Methods: Retrospective analysis of 80 cases pathologically diagnosed with pulmonary cryptococcosis between 2009 and 2018 was executed. The data of demographics, history of environmental exposure, underlying disease, clinical manifestations, laboratory examination, radiology, pathology, diagnosis and treatment were reviewed. Results: In total of 80 patients (53 males and 27 females), 49 (61.25%) were immunocompetent and mainly came from the urban. The clinical manifestations mainly performed as respiratory symptoms, including cough (52.50%), expectoration (43.75%), chest discomfort (35.00%), bloody phlegm (15.00%). The pulmonary lesions consisted of nodules/masses (55.00%), pneumonic infiltrates (7.50%) and mixed type (37.50%). The lesions were limited in immunocompetent patients. Moreover, the lesions of isolated nodules/masses were more common in surgical patients. 78.26% (18/23) of the patients had positive findings of Positron Emission Tomography (PET), which may heighten the suspicion for lung cancer. Of all patients, 57 (71.25%) were diagnosed by surgical removal of videoassisted thoracoscopic surgery (VATS) or open lung surgery, 19 were diagnosed by percutaneous needle lung biopsy (PNLB) and 4 were diagnosed by transthoracic needle lung biopsy (TNLB), respectively. Most of cases (66.25%) manifested as the granuloma, followed by dispersed pathogen (15.00%), mixed type (11.25%) and necrosis (7.50%), histologically. 65.00% of the patients were misdiagnosed, mainly including lung cancer (38.75%) and pneumonia (20.00%). The surgical patients showed a high rate of misdiagnosis with lung cancer. In total, 57 patients took antifungal treatments. The duration of the treatment ranged from 1 month to 1 year. Besides 1 case initially prescribed with itraconazole (500mg/d, 1month), 56 patients were treated by fluconazole. The surgical patients took lower dose and shorter course of fluconazole than the non-surgical patients.Conclusions: Pulmonary cryptococcosis was more common in immunocompetent host in China, with variable and nonspecific clinical features. The lesions of nodules were often misdiagnosed, which led to the lung resections of nonmalignant diseases. The dosage regimen of antifungal drugs for surgical patients need to be investigated and reached a consensus.