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We present the case of a 53-year-old man with a twenty-five pack year smoking history and a six month history of gross hematuria, who presented with a pT3a, N0, M0, muscle invasive bladder cancer (MIBC). He declined neoadjuvant chemotherapy but did receive post-cystectomy adjuvant chemotherapy. Six months post adjuvant chemotherapy he presented with abdominal pain and a large bowel obstruction, and was found to have an isolated rectal recurrence of MIBC. This case illustrates two important issues. The first being that patients with a smoking history and symptoms of hematuria need to be carefully evaluated to rule out urothelial cancer. And second, for patients with muscle invasive disease, local pelvic recurrence is common and close surveillance for recurrence needs to be implemented.

Endometriosis is a relatively common disease in women, usually of reproductive age. In rare occasions, endometriosis may occur in unusual body sites, including extragonadal, extra-pelvic sites, or in the skin. We report a case of endometriosis of the abdominal wall diagnosed by fine-needle aspiration biopsy (FNAB). The patient was a 41-year-old woman with a clinical impression of "desmoid" tumor of the abdominal wall. FNAB showed groups of epithelial cells with mild nuclear atypia and rare mitoses. A few small clusters of slightly atypical spindle cells were also seen. The initial screening impression was adenocarcinoma due to the atypical cytological features. However, after review with the pathologist, the FNAB was signed out as "endometriosis." Subsequent local excisional biopsy confirmed the diagnosis of endometriosis. In conclusion, endometriosis may present diagnostic challenges in FNAB and this possibility should be considered in differential diagnosis. A clinical cytopathological correlation is necessary to avoid a misdiagnosed as an adenocarcinoma.