Objective · To investigate the clinical manifestations, pathological features and prognostic factors of patients with adrenal lymphoma. Methods · A retrospective analysis was made with the clinical and pathological data of 77 patients with adrenal non-Hodgkins lymphoma confirmedpathology or confirmedimaging evidence in the Department of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine January 2002 to June 2018. The clinical characteristics of primary adrenal lymphoma (PAL) and secondary adrenal lymphoma (SAL) were compared. Kaplan-Meier curve was used for survival analysis, and Cox regression model was used to analyze the prognostic factors. Results · Of the 77 patients, 28 were PAL and 49 were SAL. The predominant pathological type was difflarge B-cell lymphoma, accounting for 77.9%. There were 21 patients accompaniedbone and gastrointestinal involvement, respectively. The proportions of bilateral involvement (67.9%) and large mass (67.9%) were higher in the PAL patients, while the proportions of Ⅲ / Ⅳ stage (95.9%) and pancreas (24.5%) and bone (38.8%) involvement were higher in the SAL patients. The patients with T/ NK cell-derived lymphoma or with incomplete remission after treatment had significantly shorter survival time than those with B cell-derived lymphoma or with complete remission after treatment (P0.005, P0.000). Conclusion · The clinical manifestations of adrenal lymphoma lack specificity. The main pathological type is difflarge B-cell lymphoma. Bilateral involvement and large mass are more common in PAL, while advanced disease and pancreas and bone involvement are more common in SAL. T/NK cell-derived lymphoma and incomplete remission after treatment are major adverse prognostic factors.