We report a case of leukemoid reaction associated with tumor recurrenc
e and rapid progression in a patient following resection of a high-gra
de transitional cell carcinoma of the bladder. The clinical, pathologi
c, and etiologic features of tumor-associated leukemoid reactions are
emphasized. In the setting of recurrent carcinoma, a leukemoid reactio
n suggests highly aggressive or metastatic disease.