Bladder cancer is a global disease and is one of the most common cancers worldwide. The principal risk factor is tobacco smoking, followed by occupation exposure to carcinogens and Schistosoma haematobium infection. These patients primarily present with painless gross hematuria and upon workup, with note of a bladder mass. Approximately 50% of these patients with gross hematuria have an identifiable cause with a risk for malignancy at 20.4%

Patient initally present with CT scan results of intraluminal, solid, lobulated, heterogeneously enhancing mass is seen adherent to the left lateral wall of the urinary bladder measuring 6.3 x 5.8 x 6.6 cm. TURBT was done and the histopathologic studies revealed spindle cell neoplasm, favoring leiomyoma. additional stains were requested which revealed inflammatory myofibroblastic tumor. Repeat CT urogram was done for the patient showing an increase in the size of the mass measuring 8.3 x 6.8 x 8.3 cm. Patient then underwent partial cystectomy

The case highlights the rare incidence of inflammatory myofibroblastic tumor of the bladder and its diagnostic challenges. Due to its characteristics, there is a histologic overlap between leiomyoma and IMFT. Additional staining was required to differentiate the two entities. The histological characteristics of IMT, including spindle cell proliferation and positive anaplastic lymphoma kinase (ALK) staining, differentiate it from more common bladder tumors, such as transitional cell carcinoma. The final diagnosis in the patient was an inflammatory myofibroblastic tumor of the bladder

Hematuria is the most common presentation of bladder tumors however, bladder tumors are rare in a young individual hence other pathologies must be ruled out. Appropriate histopathologic diagnosis is important and may require immunohistochemical staining in some cases hence (+) ALK stain was requested which turned out to be positive. Surgical resection is the gold standard for treatment, whether TURBT, partial cystectomy or in some cases radical cystectomy. Complete resection of the tumor has shown little to no recurrence in patients with IMFT.