Second kidney biopsy at the end of maintenance phase of therapy is an important diagnostic and prognostic tool that could guide physicians to safer practices with better outcomes.

Cystadenocarcinoma of the salivary glands is a very rare, slow growing, low-grade malignant neoplasm. However, when it occurs, it poses a diagnostic challenge. They are usually well circumscribed and exhibit multicystic appearance. The cytological features of fine-needle aspirates show bland appearing papillary and micropapillary neoplasm with variable cellularity and absence of cytological atypia. The cells are small to medium in size with abundant and occasionally vacuolated cytoplasm. The nuclei are eccentric, bland appearing, round, and at the most part uniform in size without anaplasia or mitotic activity. The background is commonly mucoid. Histologically, the neoplasm is usually well circumscribed and contains variably sized multicystic spaces with papillary structures. Foci of definite stromal invasion by tumor cells have to be present to justify the diagnosis of carcinoma. The remainders of the cytological features are similar to these seen on cytological smears. Typically, they are slow growing and conservative, but complete surgical excision is considered adequate. We present a case in a 57-year-old Saudi man that we believe the first from our region demonstrating the clinical and pathological features.

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Objectives: To identify the trends in the diagnostic frequency of glomerular disease subtypes by renal biopsy in children in Saudi Arabia over the last 20 years. Methods: In this retrospective observational study, we identified all patients aged <18 years for whom native kidney biopsy was performed between 1998 and 2017. The period during which biopsy was performed (1998-2004, 2005-2011, and 2012-2017) and the demographic information and their association with the prevalence of various glomerular disease subtypes were our primary outcomes. Results: A total of 326 cases with renal biopsy were analyzed; the mean age of participants being 11 years and 45.4% of them were girls. Unexpectedly, secondary glomerulonephritis accounted for 42.3% of the cases, and lupus nephritis was the most common cause noted in 20.7% of the cases. The minimal change and focal segmental glomerulosclerosis were the most common glomerulonephritis in 59% of the cases. The frequency of membranoproliferative glomerulonephritis and mesangioproliferative glomerulonephritis significantly decreased from 15% and 17% in the period prior to 2004 to 3.3% ( p =0.003) and 1.7% in 2012-2017 ( p <0.001). Conclusions: We found a considerable shift in the frequency of many glomerular disease subtypes in 1998-2017, which make clinical predication of the underlying etiology challenging for clinician. Renal biopsy still remains a critical diagnostic procedure for managing a considerable proportion of renal diseases.