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Sixty-three year-old-man presented with macroscopic haematuria and passage of debris per urethra. His prostate was suspicious of a T2a tumour and his PSA was 11.1 μg/l but his trans rectal ultra sound scan (TRUS) and biopsies were negative for malignancy. In the past, he had trans urethral resection (TUR) of prostate for benign hyperplasia, excision of nasopharyngeal fibroma and superficial spreading melanoma of the thigh and had supraventricular tachycardia but no ischaemic heart disease. Investigations for haematuria revealed normal upper tracts on USS. On urethroscopy, there was an annular bulbar stricture requiring urethral dilatation. Residual prostate was oedematous, vascular but non-occlusive. In the bladder, there was a yellowish white solitary plaque up to 1.5 cm on the posterior wall (Figure 1) Cold cup biopsy showed collection of macrophages with foamy cytoplasm (foam cells) in the lamina propria with a normal overlying urothelium. There was no dysplasia or neoplasia. Appearances were those of a xanthoma (Figure 2a, 2b) Blood counts, renal function, random blood sugar and LFTs were normal as was the thyroid and lipid profile. Urine cytology was normal. Follow-up cystoscopy at 6 months revealed no further lesions in the lower urinary tract and no change in the appearance of the original xanthoma. There was no evidence of transitional cell carcinoma of the bladder. There were no other xanthomatous lesions.