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Purpose: Granulomatous mastitis (GM), reported for the first time by Kessler and Wolloch in 1972, is a rare and benign inflammatory lesion of the breast. The etiology of GM is currently unknown, but some reports have suggested autoimmunity. The aim of this study was to evaluate the clinical characteristic, clinical presentations and radiological features of GM. Methods: A chart review was performed for 23 patients, with GM confirmed by a pathological examination, between July 1999 and December 2005. A retrospective review of the clinical and radiological finding, as well as the cytological results of the patients was undertaken. Results: The ages of these patients ranged between 29 and 74 years, with a mean of 39.7 years. The median follow-up was 8 months. Twenty patients (87%) presented with a mass as the chief complaint, with a median size of 2.56 cm (range 0.78~6.5 cm). Eight patients (34.8%) had radiological findings suspicious of malignancy. Tuberculosis was diagnosed using Tb-PCR in 1 patient. Twenty-two of the 23 patients underwent a wide excision, and the one remaining patient underwent incision and drainage. One of 23 patients had a recurrent disease. Conclusion: GM is a rare breast disease, which clinically mimics cancer. As radiological imaging, such as mammography or ultrasonography, are unreliable in distinguishing GM from breast cancer, further special examinations, for example FNAB and gun biopsy, are necessary. The single most important differential diagnosis of GM is tuberculosis, especially in developing countries. We suggest that the evaluation for tuberculosis is essential for the differential diagnosis of GM using clinical and pathological methods. (J Korean Surg Soc 2007;72:94-100)