Annexin II is a calcium and phospholipid binding protein and a substrate for protein-tyrosine kinases. Recent investigations have revealed involvement of annexin II in DNA synthesis and cell proliferation. Increased levels of annexin II are observed in cancer cells and tissues. To investigate the expression of annexin II in pancreatic adenocarcinoma cells and primary tumors, we measured the levels of annexin II mRNA and protein in normal human pancreas, five established human pancreatic adenocarcinoma cell lines, three primary pancreatic cancers and one metastatic tumor. All five cell lines examined had 5- to 15-fold higher levels of annexin II as compared to normal pancreas. Significant elevations (2-to 8-fold) of annexin II expression were observed in the three primary pancreatic tumors and one metastatic tumor examined. Immunocytochemical analysis indicates that the increased expression of annexin II is limited to proliferating ductular adenocarcinoma, and annexin II expression co-localizes with cells that express PCNA. In normal pancreas, annexin II expression is seen in ductal and ductular cells and no expression is seen in acinar or islet cells. We conclude from these findings that annexin II has a role in cell proliferation and its regulation is altered in pancreatic cancer.