A 68-year-old woman presented with cough and dyspnea. Chest x-ray film and computed tomography revealed atelectasis in the right upper lobe. She had a history of a bladder neoplasm, which was treated by cystectomy and chemotherapy. Flexible bronchoscopy revealed a polypoid tumor in the right upper lobe bronchus, protruding into the right main bronchus. Further, we observed the surface of the tumor by using the endocytoscopy system. The endocytoscopy system showed oval-shaped tumor cells with prominent nuclei on the surface of the tumor with a methylene blue dye staining. Biopsied specimen of the tumor demonstrated foci of metastatic urothelial carcinoma. These cancer cells were similar to the cell images of endocytoscopy system. This technology may have the potential to provide pathologic diagnosis during bronchoscopy.