As long as it remains asymptomatic such feature is likely to remain unrecognized compound libraries because the small bowel is not included in routine diagnosis of the GI-tract. If the adenocarcinoma in our patient is indeed pathogenetically connected with the mesenchymal proliferation, the malignant potential of the later is probably too low to raise a red flag in a syndrome this rare. More patients with this rare familial tumor syndrome need to be clinically evaluated to see if the mesenchymal proliferation in the small bowel should be added to the phenotypic spectrum of NBCCS. Consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests The authors declare that they have no competing interests. Authors’ contributions PP and OS drafted and wrote the paper. PP, OS and MS designed the figures. JM, CS and GM corrected the paper. PP, GM and MS provided surgical and pathological guidance. All authors were involved in treatment and diagnosis of the patient and finalized and approved the manuscript. Pre-publication history The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-2407/10/360/prepub Acknowledgements We are grateful to the patient described here for his participation in the study and like to thank Franz Jansen for excellent technical assistance.
The exponential proliferation of cancer cells and the resultant distance that develops between nutritive blood vessels and some tumour cells result in an imbalance in the supply and consumption of oxygen in solid tumours.

Such disequilibrium is a major causative factor of tumour hypoxia, a characteristic microenvironment in locally advanced solid tumours (Thomlinson and Gray, 1955; Vaupel et al, 1989). The hypoxia is closely associated with malignant phenotypes (Graeber et al, 1996), metastasis (Rofstad, 2000), invasion (Pennacchietti et al, 2003), and angiogenesis (Harris, 2002). The hypoxic fraction correlates to the resistance to chemotherapy (Teicher, 1994) and radiotherapy (Thomlinson and Gray, 1955; Brown and Wilson, 2004). Therefore, not only has AV-951 tumour hypoxia been considered an adverse prognostic indicator, but also, a hypoxia-targeting strategy is becoming increasingly important to overcome these problems (Teicher, 1994; Harris, 2002; Brown and Wilson, 2004).