# PathMem: Toward Cognition-Aligned Memory Transformation for Pathology MLLMs

arXiv: https://arxiv.org/abs/2603.09943 · HTML: https://mlsanity.com/paper/2603.09943/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 36 of its 71 references that are in the map.
- First posted on arXiv 10 Mar 2026.

## Builds on (most cited first, 30 of 36)

- [Visual Instruction Tuning](https://mlsanity.com/paper/2304.08485/) (2023)
- [A Survey on Multimodal Large Language Models](https://mlsanity.com/paper/2306.13549/) (2023)
- [Multimodal Whole Slide Foundation Model for Pathology](https://mlsanity.com/paper/2411.19666/) (2024)
- [The Revolution of Multimodal Large Language Models: A Survey](https://mlsanity.com/paper/2402.12451/) (2024)
- [Quilt-LLaVA: Visual Instruction Tuning by Extracting Localized Narratives from Open-Source Histopathology Videos](https://mlsanity.com/paper/2312.04746/) (2023)
- [PRISM: A Multi-Modal Generative Foundation Model for Slide-Level Histopathology](https://mlsanity.com/paper/2405.10254/) (2024)
- [PathAsst: A Generative Foundation AI Assistant Towards Artificial General Intelligence of Pathology](https://mlsanity.com/paper/2305.15072/) (2023)
- [SlideChat: A Large Vision-Language Assistant for Whole-Slide Pathology Image Understanding](https://mlsanity.com/paper/2410.11761/) (2024)
- [Mem-Gallery: Benchmarking Multimodal Long-Term Conversational Memory for MLLM Agents](https://mlsanity.com/paper/2601.03515/) (2026)
- [PathMMU: A Massive Multimodal Expert-Level Benchmark for Understanding and Reasoning in Pathology](https://mlsanity.com/paper/2401.16355/) (2024)
- [HistGen: Histopathology Report Generation via Local-Global Feature Encoding and Cross-modal Context Interaction](https://mlsanity.com/paper/2403.05396/) (2024)
- [WSI-LLaVA: A Multimodal Large Language Model for Whole Slide Image](https://mlsanity.com/paper/2412.02141/) (2024)
- [WSI-VQA: Interpreting Whole Slide Images by Generative Visual Question Answering](https://mlsanity.com/paper/2407.05603/) (2024)
- [CPath-Omni: A Unified Multimodal Foundation Model for Patch and Whole Slide Image Analysis in Computational Pathology](https://mlsanity.com/paper/2412.12077/) (2024)
- [WsiCaption: Multiple Instance Generation of Pathology Reports for Gigapixel Whole-Slide Images](https://mlsanity.com/paper/2311.16480/) (2023)
- [Unveiling the Ignorance of MLLMs: Seeing Clearly, Answering Incorrectly](https://mlsanity.com/paper/2406.10638/) (2024)
- [PathAlign: A vision-language model for whole slide images in histopathology](https://mlsanity.com/paper/2406.19578/) (2024)
- [Evidence-based diagnostic reasoning with multi-agent copilot for human pathology](https://mlsanity.com/paper/2506.20964/) (2025)
- [PathAgent: Toward Interpretable Analysis of Whole-slide Pathology Images via Large Language Model-based Agentic Reasoning](https://mlsanity.com/paper/2511.17052/) (2025)
- [Patho-AgenticRAG: Towards Multimodal Agentic Retrieval-Augmented Generation for Pathology VLMs via Reinforcement Learning](https://mlsanity.com/paper/2508.02258/) (2025)
- [SYNAPSE: Empowering LLM Agents with Episodic-Semantic Memory via Spreading Activation](https://mlsanity.com/paper/2601.02744/) (2026)
- [LLaVA Needs More Knowledge: Retrieval Augmented Natural Language Generation with Knowledge Graph for Explaining Thoracic Pathologies](https://mlsanity.com/paper/2410.04749/) (2024)
- [Aligning Knowledge Concepts to Whole Slide Images for Precise Histopathology Image Analysis](https://mlsanity.com/paper/2411.18101/) (2024)
- [Multi-Modal Foundation Models for Computational Pathology: A Survey](https://mlsanity.com/paper/2503.09091/) (2025)
- [PathReasoner-R1: Instilling Structured Reasoning into Pathology Vision-Language Model via Knowledge-Guided Policy Optimization](https://mlsanity.com/paper/2601.21617/) (2026)
- [Memory-Augmented Multimodal LLMs for Surgical VQA via Self-Contained Inquiry](https://mlsanity.com/paper/2411.10937/) (2024)
- [LoC-Path: Learning to Compress for Pathology Multimodal Large Language Models](https://mlsanity.com/paper/2512.05391/) (2025)
- [AMA: Adaptive Memory via Multi-Agent Collaboration](https://mlsanity.com/paper/2601.20352/) (2026)
- [SynapticRAG: Enhancing Temporal Memory Retrieval in Large Language Models through Synaptic Mechanisms](https://mlsanity.com/paper/2410.13553/) (2024)
- [If Attention Serves as a Cognitive Model of Human Memory Retrieval, What is the Plausible Memory Representation?](https://mlsanity.com/paper/2502.11469/) (2025)

## Built on by (most cited first, 1 of 1)

- [SlideBank: A Persistent Hierarchical Evidence Bank for Consistent Whole-Slide Reasoning](https://mlsanity.com/paper/2609.00342/) (2026)

## Abstract (arXiv)

Computational pathology demands both visual pattern recognition and dynamic integration of structured domain knowledge, including taxonomy, grading criteria, and clinical evidence. In practice, diagnostic reasoning requires linking morphological evidence with formal diagnostic and grading criteria. Although multimodal large language models (MLLMs) demonstrate strong vision language reasoning capabilities, they lack explicit mechanisms for structured knowledge integration and interpretable memory control. As a result, existing models struggle to consistently incorporate pathology-specific diagnostic standards during reasoning. Inspired by the hierarchical memory process of human pathologists, we propose PathMem, a memory-centric multimodal framework for pathology MLLMs. PathMem organizes structured pathology knowledge as a long-term memory (LTM) and introduces a Memory Transformer that models the dynamic transition from LTM to working memory (WM) through multimodal memory activation and context-aware knowledge grounding, enabling context-aware memory refinement for downstream reasoning. PathMem achieves SOTA performance across benchmarks, improving WSI-Bench report generation (12.8% WSI-Precision, 10.1% WSI-Relevance) and open-ended diagnosis by 9.7% and 8.9% over prior WSI-based models.