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New case (obviously) and possibly a new motherboard, although it may already have something that can go into a smaller case. May also need a new power supply.
It depends how small you want to go, microATX would be the easiest probably. This kind of size http://www.ebuyer.com/store/Components/cat/Computer-Cases/subcat/Micro-ATX-Cases
EDIT: New page, what they all said.
I have a big desktop tower what do I need to consider the put in smaller case? It's huge ATM.