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Primary bladder perivascular epithelioid cell tumours (PEComas) are rare tumours that typically present in the third or fourth decade of life. Radiological and histopathological findings play a crucial role in establishing the diagnosis, and treatment is primarily based on surgical excision. We present the case of a primary bladder PEComa in an early adolescent male presenting with macroscopic haematuria and a hypervascular bladder mass. These peculiar symptoms should prompt consideration of the rare diagnosis of PEComa, even in paediatric patients.