Malignant solitary fibrous tumors (SFT) of the kidney are an unusual entity. In a search of the medical literature, this tumor has never been described in a renal allograft. We report a case of a 70-year-old female who developed a bifocal malignant SFT in a renal allograft 12 years after transplantation. The patient underwent enucleation of both lesions. Microscopic evaluation showed neoplastic proliferation of spindle-shaped cells showing moderate atypia and frequent mitotic figures. At 12-month follow-up, the patient was tumor-free and had preserved renal allograft function. Although transplant nephrectomy might be the conventional treatment for this pathology, a nephron-sparing surgical approach allowed for the removal of both tumors while preserving allograft function. In this case, an informed patient dictated a treatment modality that would best maintain her high quality of life coupled with a reasonable expectation of a cure.
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