Lymphomas are cancers of the lymphoid tissue, which is part of our body's immune system. One of the most important cells in our immune system is a type of white blood cell called a lymphocyte. There are two types of lymphocytes: 'B-cells' and 'T-cells'. All lymphocytes are produced in the bone marrow and start life as young, immature cells called stem cells. Some lymphocytes continue their development in the bone marrow or lymph nodes and these are called B-cells but others move to the thymus gland and they are called T-cells. The description and classification of the various types of non-Hodgkin’s lymphoma has developed over the years as more has been learnt both about the immune system and the cancers themselves. The most recent classification divides non-Hodgkin’s lymphoma into some fifteen different tumour types. Each of these will have different patterns of behaviour and may need different approaches to treatment.

This type of lymphoma is a T-cell lymphoma and is uncommon. It is only seen in people with coeliac disease. This is an immune condition where people are allergic to a component of wheat called gluten. This causes inflammation of the gut lining and stops it being able to absorb all the necessary nutrients form the diet. This is the meaning of the word ‘enteropathy’ -  a disease of the gut. Some cases of this type of lymphoma occur in people who already know that they have coeliac disease. Most cases though happen in people who are unaware of the fact that they have celiac disease and both this and the lymphoma are diagnosed at the same time. Most types of NHL usually appear as painless swellings in the neck, armpit or groin, caused by enlarged lymph nodes. This type of lymphoma is different in that it only involves the gut with multiple ulcerated thickened areas in the gut wall occasionally merging into one mass. People usually are diagnosed when they present with belly pain or when the gut wall breaks down.

The diagnosis is usually made at an operation, where a biopsy is taken away of the abnormal tissue to examine under the microscope. Additional tests, including blood tests, x-rays, scans and bone marrow samples, are then used to get more information about the lymphoma and to see if it has spread elsewhere in the body. This is important in deciding treatment.

The outlook is very variable. Often these patients are very ill at diagnosis because of their abdominal problems and because of the chronic malabsorption from their celiac disease. However,  some do respond to chemotherapy and there are long-term survivors from this condition. All patients who are diagnosed with celiac disease will need to go on a gluten-free diet to allow the lining of the gut to repair itself and start working normally again.