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Neuroendocrine carcinoma of the urinary bladder is an exceedingly rare pathology, comprising 0.35- 0.70% of all bladder cancers. The presenting symptoms and gross morphology are identical to conventional urothelial carcinoma, but the prognosis is much worse with frequent metastasis. Neuroendocrine carcinoma has been subdivided into small cell and large cell carcinoma. Hematuria is the main symptom with some patients having associated paraneoplastic conditions. The cell of origin of neuroendocrine carcinoma is from a multipotential stem cell with the ability to differentiate to other types. We report a case of 76 yr old male who presented with history of hematuria was diagnosed on bladder biopsy as neuroendocroine carcinoma bladder (100%) with diffuse synaptophysin positivity, Ki 67 indexx of 85% and negative p63. The treatment of neuroendocrine carcinoma of the bladder is not standardised and the prognosis is poor; however, cisplatin-based chemotherapy regimens seem to have a better prognosis.