Summary We have analysed 15 infiltrating duct carcinomas of the breast, 10 gastrointestinal adenocarcinomas, one each of the thyroid and larynx, and four mesenchymal tumours for the presence and the nature of procoagulant activity (PCA). The metastatic tumours had a significantly higher PCA (P = 0.01-0.001) as compared to the non-metastatic tumours in the respective groups, and almost 20-25 times the activity as comnpared to normal tissue (P = 0.001). Although the majority of the tumours had FVII-dependent tissue thromboplastin-like activity, some of the tumour homogenates revealed the presence of an FVII-independent PCA. Unlike the known alternate PCA, which acts via factor X activation, this PCA was factor X independent. It caused clot formation in FX-deficient plasma (six cases) and purified fibrinogen solution (four cases), indicating the presence of a Xa-like enzyme or a thrombin-like activity respectively.As early as 1938, Sproule recognised the association between malignancy and alterations in haemostasis. Since then, it is well known that malignant disease is associated with a high incidence of vascular thrombosis or disseminated intravascular coagulation (Rickles & Edwards, 1983). Deposition of fibrin within and around the tumour has been convincingly demonstrated immunohistochemically and ultrastructurally (Rickles & Edwards, 1983) but its precise role in the growth and spread of the tumour is largely unknown. O'Meara (1958) first described the procoagulant activity of cancer cells. PCA could be present at the cancer cell surface or secreted by it, and may be of two types: (a) FVII-dependent, tissue thromboplastin activity (Rickles & Edwards, 1983;Markus, 1984;Cajot et al., 1986); (b) FVII-independent, direct FX activator (Curatolo et al., 1979;Hilgard & Whur, 1980;Gordon & Cross, 1981
Results
PCA of breast tumoursThe mean PCA of metastatic infiltrating duct carcinoma was 76.1 % (range 15-150% of HBT) and was significantly higher