Pancreatic adenocarcinomas are highly invasive cancers for reasons that are currently unclear. Here we sought to determine if the proinvasive integrin a6b4 may be related to pancreatic adenocarcinoma tumor progression. Expression of integrin a6b4 was analyzed via immunohistochemistry for the b4 subunit in normal pancreas, pancreatic intraepithelial neoplasia (PanIN) lesions, pancreatic adenocarcinomas and chronic pancreatitis. In normal pancreatic ducts, integrin a6b4 was noted only at the cell's basal interface with the basement membrane. In pancreatic adenocarcinomas, 92% (104/113) demonstrated overexpression of integrin a6b4 and altered localization to the cytoplasm and membranous regions. This pattern of expression was observed in all PanIN lesions as early as PanIN-1A, and was evident in lesions that were juxtapositioned to normal epithelium. In contrast, 93% (13/14) of chronic pancreatitis samples resembled the staining pattern of normal pancreas. When cancer was present in areas of chronic pancreatitis, this altered expression of a6b4 integrin identified the cancer. We conclude that integrin a6b4 is expressed only on the basal surface of ductal cells in normal pancreas and chronic pancreatitis. During pancreatic adenocarcinoma progression, the a6b4 integrin is dramatically overexpressed and displays altered localization at the earliest stages of PanIN, thus representing an early event in pancreatic adenocarcinoma progression. Keywords: pancreatic intraepithelial neoplasia (PanINs); immunohistochemistry; precursor lesion; integrins; pancreatic cancer; chronic pancreatitis Pancreatic carcinoma is the fourth leading cause of cancer death in the US and has the highest death to incidence ratio of all cancers. 1 Poor prognosis of pancreatic cancer patients relates to a high incidence of tumor cell invasion and metastasis. Treatment options are limited and patients succumb to the disease shortly after diagnosis unless eligible for tumor resection. 2 Of those patients that undergo resection, only 15-20% will survive to 5 years. 1 Over 90% of pancreatic cancers are adenocarcinomas that are thought to arise from proliferative premalignant pancreatic intraepithelial neoplasia (PanIN) of the ductal epithelium. PanIN lesions start as low cuboidal epithelial cells that become columnar due to increased mucin production. Cells then present with nuclear atypia and enhanced proliferation, which lead to luminal shedding and/ or invasion into the stroma. 3 These morphological alterations correlate with increased genetic abnormalities such as the activation of K-ras, loss of tumor suppressors (eg p16, p53 and DPC4) and upregulation of telomerases. 4 Although PanIN-1A and PanIN-1B are considered early cancer precursor lesions, molecular studies have shown that PanIN-2 and PanIN-3 lesions represent a distinct step toward invasive carcinoma. 5 Moreover, PanIN lesions can be found in patients with chronic pancreatitis 6 and these patients have an increased risk of developing pancreatic cancer. 7,8 Infiltrating duct-like and tubul...