We report a rare case of metastatic malignant solitary fibrous tumor (SFT) that 
presented with hypoglycemia because of insulin growth factor-2 production. 
Initial workup included computed tomography imaging that revealed a large, 
partially necrotic liver mass, a hypervascular pancreatic head lesion, and 2 
renal lesions. Following hepatic resection, pancreatic head resection and 
nephrectomy, all these lesions demonstrated pathological findings that were 
consistent with SFT. The patient also had a history of an intracranial mass that 
had been previously resected and treated with gamma knife therapy at an outside 
institution, which was found to also be SFT. Six months after initial pancreatic 
head resection, the patient developed a new lesion involving the pancreatic tail 
that was found to represent recurrent metastatic SFT. This case emphasizes the 
highly aggressive nature of extrapleural SFT, while rare, and the role of 
imaging in follow-up for disease recurrence.