As far as ALK-1 cytoplasmic expression is concerned, this has been identified in a range of 8% to 89% of IMT cases in the urinary bladder [20] and in the current report as well; albeit being suggestive of a neoplastic rather than a reactive or inflammatory nature and consistent with abundant mitoses and prominent atypia, the present ALK-positive lesion has neither recurred nor metastasized 3 years post-operatively. Here, ALK is linked to inflammatory myofibroblastic tumor.