Review of pulmonary biopsies received by Birmingham Women’s Hospital to identify which gynecologic tumors most commonly metastasize to lung or pleura, and which may first present with pulmonary metastases. We reviewed all pulmonary biopsies over a 14-yr period. There were 25 lung and 9 pleural biopsies, from 33 patients. Twenty-one patients had known gynecologic tumors (1 vulval, 1 cervical, 9 endometrial, 4 uterine mesenchymal, and 6 ovarian). Eighteen of the 21 biopsies had been referred from other hospitals; in 4 cases review lead to an altered diagnosis. Three of the 21 biopsies had been sent directly to Birmingham Women’s Hospital. The interval between primary diagnosis and pulmonary metastasis was known in 18/21 cases and ranged from 1 to 17 yr. Nine of 21 (43%) had metastatic endometrial carcinoma; the International Federation of Gynecology and Obstetrics (FIGO) stage was known in 7/8 cases: Stage I in 5, and II and IIIA in the remaining 2 cases. Of the further 12 patients with no history of gynecologic malignancy, 4 had pleural metastases from ovarian carcinoma, 3 had primary lung carcinoma, 3 had carcinoma of unknown primary, 1 had endometrial stromal sarcoma, and 1 with a suspected Müllerian tumor was lost to follow-up. Pulmonary metastasis can occur many years after a diagnosis of gynecologic neoplasia—usually endometrial carcinoma, even after initial presentation at low stage. It may also be the initial manifestation in some cases—particularly ovarian carcinoma with pleural involvement. Specialist review of lung and pleural biopsies is important to confirm the diagnosis and optimize patient management.