ALK and anemia: Clinical presentation mostly dependant on site of origin in case of bladder IMT gross hematuria most common presentation, supra pubic pain, storage lower urinary tract symptoms and if bleeding is severe enough they may have systemic symptoms of anemia.Management is aimed at complete local resection through transurethral resection or partial cystectomy is the more advisable treatment.Anaplastic lymphoma kinase (ALK) inhibitor can be considered for selected patients.