Epithelioid Fibrous Histiocytoma (EFH) With Rare PPFIBP1-ALK Fusion: A Predominantly Spindle Cell Variant Within the Emerging Spectrum of Myxoid Spindle Cell EFH

Epithelioid fibrous histiocytoma (EFH) is a benign fibrohistiocytic neoplasm characterized by morphologic heterogeneity and recurrent anaplastic lymphoma kinase (<i>ALK</i>) gene rearrangements. We present a rare case of EFH located on the lateral neck of a 56-year-old male patient, demonstrating a predominantly spindle cell morphology. Immunohistochemical analysis revealed granular cytoplasmic positivity for ALK, along with expression of CD68, CD4, epithelial membrane antigen, caldesmon, and smooth muscle actin. Next-generation sequencing confirmed the presence of a rare <i>PPFIBP1-ALK</i> fusion. The presented case highlights a predominantly spindle cell variant of EFH and suggests inclusion within the recently described myxoid spindle cell EFH spectrum, which encompasses the superficial ALK-rearranged myxoid spindle cell neoplasms (SAMS).