Xanthomas of the urinary bladder are rare lesions of reactive nature. They present as yellow-white mucosal plaques that may be mistaken for a neoplastic process. A biopsy displays stromal accumulation of lipid macrophages without accompanying inflammatory component. This article presents a 78-year-old woman who had a tumour-suspect xanthoma of the urinary bladder occurring subsequent to several resections of non-invasive carcinomas.