Malignant fibrous histiocytoma (MFH) of the tongue is an extremely rare subgroup of primary head and neck aggressive sarcomas with only six cases documented. Current recommended treatment in head and neck MFHs is wide resection of the tumor with adequate margins. However, technically this aggressive tumor type forms a challenging group for surgery due to difficulties in achieving tumor free margins without significant cosmetic and functional impairment. Elective neck dissection is not considered as a standard surgical option in head and neck MFHs, except for those patients presented with advanced stage and aggressive tumor histology. Local recurrences occur in 50% of head and neck MFHs treated with surgery alone, therefore adjuvant radiation therapy has an essential role in management of this aggressive tumor group. However, the role of postoperative radiation therapy in primary MFHs of tongue has not been addressed yet. In this report, we describe a further case of primary tongue MFH with positive surgical margins treated with postoperative radiation therapy in curative intent, and its clinical course following treatment. To our knowledge this is the first report of postoperative experience in MFHs of this disease site. Additionally, we review the clinicopathologic features and treatment aspects of all cases documented in the literature.