Isolated fibrous tumor (SFT) of the chest has a high rate of clinical and imaging misdiagnosis. Complete resection of SFT is more effective, but how to effectively prolong the survival of patients with multiple recurrences and malignant SFT remains a challenge for clinicians. Primary tumors of the pleura are classified into two categories: diffuse mesothelioma and limited mesothelioma. SFT originates from mesenchymal tissue and is not associated with a history of asbestos exposure, the associated risk factors are unclear, and the prognosis is mostly favorable, but 10%-20% of SFTs have a tendency to become malignant. Reoperation after recurrence is still effective in prolonging survival, but once metastasized, the prognosis is poor. The incidence of SFT is highest between the ages of 50 and 60 years with no significant gender differences, and familial incidence and related genetic studies have been rarely reported. Patients with SFT do not have specific clinical symptoms, but they may have associated tumor syndromes such as pestle and mortar, osteoarthropathy, and hypoglycemia. Hypoglycemia mostly occurs in large tumors with an average diameter of about 500px, and 40% of combined hypoglycemia are malignant SFTs, probably because the tumor can produce irrepressible insulin-like active substances and insulin-like growth factors, and the symptoms usually disappear after complete removal of the tumor. Almost 100% of malignant SFTs have inhomogeneous density enhancement in enhanced CT, while only 60% of benign SFTs are found. Malignant SFT should be considered if the tumor is larger than 250 px in diameter and is closely related to surrounding tissue. The intra-tumoral blood flow effect of SFT is not significant and is not related to malignant potential. Malignant SFT tends to be homogeneous with a high metabolic rate, and the variety of morphology also facilitates the determination of malignancy. Thoracic SFT needs to be differentiated from sarcomas, isolated mesotheliomas, and benign and malignant tumors of the lung. The final diagnosis of SFT still requires immunohistochemistry. It is controversial whether preoperative CT-guided (or tracheoscopic) aspiration for pathology should be performed. Currently, complete surgical resection remains the primary treatment for SFT. For tumors without a wide base in the chest wall, resection should be expanded accordingly, even requiring chest wall repair and skin grafting if necessary. Lymph node metastasis is rare and does not require contouring of mediastinal lymph nodes. The main factors affecting the survival rate are tumor stage and standard surgical treatment, not related to the size of the tumor. There is no international gold standard for chemotherapy, but from the experience of treating other soft tissue sarcomas, doxorubicin plus isocyclophosphamide based chemotherapy should be the first choice. The combination of temozolomide and bevacizumab and the application of tyrosine kinase inhibitors have shown initial success and are currently in phase II clinical trials. Due to the special origin of SFT, the factors affecting its prognosis have yet to be summarized in a large number of clinical studies. It is believed that as the understanding of SFT gradually deepens, the level of its diagnosis and treatment will be greatly improved.