Objectives: The objectives of this study were to provide an outlook of urothelial carcinoma through the immunohistochemical expression patterns of octamer-binding transcription factor 4 (OCT4) in high-grade transitional cell carcinoma (TCC) of the urinary bladder. Methods: A total number of 60 tissue samples were collected for the study. Patients were divided into two groups according to the pathological diagnosis of the bladder tissue, Group A: 30 cases with high-grade TCC of the bladder and Group B: 30 cases with apparently normal bladder tissue. Tissue immunohistochemical analysis was applied to investigate the expression patterns of cancer stem cell (CSC) markers OCT4 in bladder samples. Results: OCT4 was positive in 80% of specimens of Group A and 3.3% in specimens of Group B. The association between OCT4 marker result and certain histopathological features in high-grade group: Positive OCT4 result was found in patients with inflammation and necrosis (90.9%) with a significant association (p=0.013). Regarding muscular invasion, we noticed that 87.5% of patients with muscular invasion showed positive OCT4 marker result with a significant association (p=0.039) between OCT4 marker result and muscular invasion. As well, OCT4 marker was highly sensitive and specific (sensitivity=66.7%, specificity=96.7%, and accuracy=76.7%). Conclusion: There was a significant expression of CSC OCT4 in high-grade TCC, OCT4 can be considered as a key regulator of tumor progression, aggressive behavior, and metastasis.