A 52-year-old man presented with a 6-month history of gross hematuria and worsening frequency/urgency. He had no comorbitities and smoked 1 ppd. A computed tomography of the abdomen and pelvis demonstrated left hydronephrosis and a large bladder mass. A cystoscopy confirmed a vascular bladder tumor obstructing the bladder neck. Transurethral resection revealed an invasive urothelial carcinoma with squamous differentiation. After discussing the various treatment options, the patient underwent a radical cystectomy, pelvic lymphadenectomy, and ileal neobladder reconstruction. The postoperative recovery was uneventful. The pathology revealed an invasive carcinoma with stage pT2N3 and negative surgical margins. Of the 39 nodes resected, 6 had nodal metastasis. Given the high risk of recurrence, the patient subsequently received four cycles of adjuvant gemcitabine and cisplatin, which were well tolerated. No evidence of disease was noted at the time of last follow-up (10 months from the date of surgery).