is the smallest mini-itx case i know of with a full size expansion slot. Weither its PCI or something else will depend on what motherboard you put in it.
The 60mm fans can be replace with 80mm fans with a bit of modification. Get some nexus 80mm fans and undervolt them and cut out the case fan grills and it should be very quiet.
I have one of these cases, though its an older version without the stock fans. I ended up cutting a hole in the front of the case below the slim optical bay and put an 80mm fan there as an intake that blew cold air directly over the passive CPU and passive GPU heatsinks. I had a C2D processor with a stock passive single slot 7600GS. It actually did fairly well with gamming. Only really hard part was finding a PCI-e 16x riser card, ended up having to use a flexible riser cable. Though if your using a PCI expansion slot, the case comes with a PCI riser card that fits the case perfectly.
I used a pico-psu for DC/DC conversion inside the case, and a 220w external passive AC/DC adapter. I also modded 2x wifi antenna to the back of the case, one on each end, that connected to a PCMCIA intel 802.11a/b/g wifi card.