Invasive urothelial carcinoma has a propensity for disparate differentiation and presentation of morphological variants. Sarcomatoid carcinoma (SaC) of the bladder is an extremely uncommon and aggressive variant of bladder cancer. An accurate diagnosis for this variant is necessary, but at times difficult. Immunohistochemistry can increase the diagnostic accuracy for SaC. The therapeutic approaches currently adopted for the treatment of SaC are similar to those used for the urothelial variant: Surgery, chemotherapy and radiation therapy. To date, however, there exists no standard treatment due to the lack of knowledge regarding the pathogenesis of SaC. Future research is required to focus on this rare histological tumor subtype in order to identify more effective treatment strategies. The present study reported an unusual case of bladder SaC in a woman aged 48 years, who was a non-smoker with a long history of benzodiazepine abuse. Although saving the patient's life was a priority, it was also essential to consider her subsequent quality of life. For that reason, the patient underwent a cystectomy with orthotopic neobladder reconstruction using ileum, followed by chemotherapy. At the 7 month follow-up, the patient was still alive, in complete remission and had normal bladder function. The present case report shows the potential contribution of benzodiazepine abuse in the development of a bladder sarcomatoid carcinoma, a rare variant of BC, whose early detection and accurate diagnosis are key to attaining satisfactory treatment outcomes and a favorable prognosis for patients.