The EWSR1::PBX3 fusion gene, commonly associated with cutaneous syncytial myoepitheliomas, is also found in myoepithelial tumors (METs) of bone and soft tissue. These tumors typically demonstrate benign histology and favorable outcomes. This study examines six previously unreported intraosseous METs harboring the EWSR1::PBX3 fusion, focusing on their histopathologic characteristics, immunophenotype, clinical and radiographic profiles, and patient outcomes. The cohort comprised five males and one female, aged 25 to 65 years (median age 31), with tumors located in the proximal tibia (three cases), distal radius (two cases), and ilium (one case), and sizes between 3.2 to 12.2 cm (median size 3.9 cm). Imaging showed osteolytic lesions with varying degrees of cortical involvement and soft tissue extension in three cases. Histologically, four tumors showed mainly uniform oval-to-spindled cells in syncytial or fascicular arrangements within a collagenous matrix, displaying either bland nuclear features or mild atypia, and low to slightly elevated mitotic activity (≤1 per 10 HPF in three cases and 6 per 10 HPFs in one), classifying them as benign or atypical METs. In contrast, two tumors exhibited pronounced nuclear atypia with ovoid, spindled, epithelioid and round cells, hyperchromatic nuclei, inconspicuous nucleoli, increased N/C ratios, high mitotic rates (17 and 19 per 10 HPFs), and extensive necrosis. Both tumors behaved aggressively-one patient underwent amputation after neoadjuvant chemotherapy and radiation, while the other died with the disease. Immunohistochemically, the tumors consistently expressed EMA and S100, but lacked keratin (AE1/AE3) expression. Our study demonstrates that bone METs with EWSR1::PBX3 fusions encompass a histologic continuum from benign to malignant, with benign/atypical METs mirroring their cutaneous analogs in morphology and malignant variants distinguished by heterogenous cytologic and architectural features, pronounced nuclear atypia, and high mitotic rates.