An extensive biomedical literature attests to the controversy regarding the significance of coagulation activation in cancer. It has been known for over a century that thromboembolism may complicate the course of malignancy (1) and that fibrin may occur in association with intravascular tumor deposits in humans (2). That peripheral blood coagulation changes, indicative of disseminated intravascular coagulation (DIC), occur regularly in cancer is common knowledge (3). However, the biological significance of such activation of blood coagulation is still not completely clear. Some investigators claim that it is only an insignificant epiphenomenon in a disease that often involves multiple organ systems and that uses the bloodstream for metastatic dissemination. However, other investigators, on the basis of recent clinical and experimental data, including therapeutic intervention studies with antithrombotic drugs, have argued that such activation of the coagulation mechanism might be capable of contributing to progression of malignancy (4-11). The purpose of this review is to evaluate critically the evidence that addresses the significance of blood coagulation activation in malignancy by analyzing the extent, pattern, and possible role of fibrin deposition in situ in tumor tissues. Particular emphasis will be placed on defining the evident heterogeneity that exists between tumor types in an attempt to interpret the existing literature on the coagulation-cancer interaction that is both intriguing and confusing. Fibrin Deposition in Solid Tumors O'Meara (12) first called attention to the possibility of fibrin deposition in solid tumors. However, more convincing evidence that fibrinogen-related proteins were localized in solid tumors came from the work of investigators who showed that systemic administration of fibrinogen together with antifibrinogen antibody leads to their sequestration in animal and human tumors (13, I4).Laki and Yancey (15) reviewed their earlier work that showed direct conversion of fibrinogen to fibrin by cultured malignant cells that were placed in a fibrinogen solution. Fibrin was observed by electron microscopy adjacent to these tumor cells following their innoculation into mice. Other investigators demonstrated fibrinogen-related proteins by immunofluorescence in several experimental and human neoplasms (15, 16). The conclusions derived from these early reports, the results of which Supported in part by the Italian Association for Cancer Research (A.I.R.C.), Milan, Italy (V.C.