OBJECTIVE Primary bladder adenocarcinoma is a rare entity. We performed a review of the literature on this subject and present a clinical case. METHOD/RESULTS A 74 year old female patient presents to the emergency department with complaints of gross hematúria not accompanied by lower urinary tract symptoms. Diagnostic work-up included renal and bladder ultrasound, cistoscopy and abdomino-pelvic C. T. scan. Metastatic disease was excluded. Trans-urethral resection revealed an invasive adenocarcinoma. A gynaecologic origin was excluded by further gynaecologic examination and an anterior pelvic exanteration was performed. The bladder specimen showed primary bladder adenocarcinoma, pT3aNO. At 6 months of follow-up, the patient does not present disease progression or surgical complications. CONCLUSION Primary bladder adenocarcinoma is rare. Unlike urothelial carcinoma, it responds poorly to chemotherapy or radiotherapy Radical Cistectomy offer the best chance of long-term survival.