Solitary fibrous tumors (SFT) are rare, ubiquitous neoplasms of mesenchymal origin, with distinctive histopathological and immunohistochemical features. We herein report an unusual case of a presacral SFT diagnosed in an asymptomatic 40-year-old woman preoperatively investigated with computed tomography and magnetic resonance imaging. Post-operative pathology examination showed a SFT containing foci of extramedullary hematopoiesis. Revision of preoperative imaging did not evidenced any findings suggesting this unusual association. The patient was free from local recurrence and metastases one year after operation. Differential radiological and histological diagnoses of solid presacral masses is briefly discussed.