CTSB and neoplasm: Tumor cells can activate coagulation pathway by a direct and an indirect mechanism: the direct mechanism involves the production of pro-coagulant factors such as the tissue factor which is constitutively expressed by tumor cells and which binds factor VII and activates coagulation pathway; and the cancer procoagulant, a cysteine protease expressed in tumor cells and in fetal tissues which activates factor X in absence of factor VII [9,10].