A 25-year-old male was referred to our hospital with progressive right chest pain and neck pain on March 2014, 4 months after the third time of right-side occipital craniotomy. Initially, he presented with headache, nausea and visual disturbances without obvious cause on December 2012. Magnetic resonance imaging (MRI) revealed intracranial tumor apoplexy of right occipital lobe at local hospital. First right-side occipital craniotomy was performed on 22th December 2012. Postoperation histopathology revealed spindle cell tumor, anaplastic meningioma was a preferred diagnosis. Then he complained of repeat headaches. Follow-up MRI showed a recurrence of tumor in the same location. The second and third open surgery was performed successively on 21th November 2013 and 31th December 2013. Postoperative conformal radiotherapy was administered for two times at doses of 54Gy and 46Gy on13th March 2013 and 17th January 2014, respectively. All these treatments were performed at local hospital. After he was admitted to our hospital, positron emission tomography/computed tomography (PET/CT) showed tumor recurrence of the right occipital lobe, several massive or nodular shadows were seen in both lungs, the biggest lesion size was 5.0 cm × 5.1 cm × 5.5 cm. The average SUV values were 4.0 in PET scan, with the maximum SUV values was 7.3. Many nodular and patchy thick radioactive lesions were seen in the left attachments of the 5th cervical and the 7th thoracic vertebrae, the right attachments of the 1st, 2nd and 5th thoracic vertebrae, the left 3rd and 6th lateral ribs, the left 6th rear rib, the right 5th and 9th rear ribs, the right attachments of the 1st and 4th lumbar vertebrae, the 5th lumbar vertebral body, the left iliac wing, the sacrum, the right ischium and the upper parts of both femurs. The average SUV value was 4.9, with the maximum SUV value was 8.1. Bone destructions were seen in these lesions under CT scan. Ultrasound guided puncture biopsy of left-side back of the neck and CT guided puncture biopsy of the third lumbar vertebra were performed. Biopsy samples of left-side back of the neck and the third lumbar vertebra showed grayish white or grayish red with irregular shapes. Microscopic findings showed the tumor was composed of atypical cells arranged as fascicular, storiform or patternless pattern with intervening irregular hyalinzed collagen bundles. Hypercellularity or hypocellularity, perivascular hyalinization and hemangiopericytoma-like pattern were seen in some areas. Coagulative necrosis and increased mitotic activity (>4 mitoses/10HPF) were noted in the tumor. Immunohistochemically, tumor cells were diffusely positive for Vimentin and CD99, focal positive for CD34, Bcl-2 and Actin, negative for CK, EMA, Desmin, CD117, GFAP, PR and S-100. Ki-67 index was more than 40 %, consistent with MSFT. Pathologic examination was performed on the HE slides of the right occipital lobe tumor made by former local hospital. Similar morphological change and the same immunohistochemistry phenotype were found. With these features, final pathological diagnosis is MSFT of the right occipital lobe and metastatic MSFT of left-side back of the neck and the third lumbar vertebra.