Spatial Message Passing in Language Space for Pathology Image Interpretation

Multimodal Large Language Models (MLLMs) can generate pathological descriptions from histological images, but gigapixel Whole Slide Images (WSIs) exceed their visual context limits. The standard tiling workaround makes WSIs tractable yet severs the tissue neighborhoods that define tumor-stroma interfaces and morphology. We introduce Spatial Language Message Passing (SLMP), a framework that performs spatial reasoning entirely in language space, human-readable by construction. SLMP represents a WSI region as a spatial text graph: tiles are nodes initialized with MLLM descriptions, and edges encode spatial adjacency. For each tile, an LLM refines its description by integrating language messages from adjacent tiles under a shared aggregation policy that, on the tile grid, acts as an adaptive local kernel operating on text rather than learned embeddings. This policy is an inspectable prompt that can be refined from model-observed tissue phenotypes via textual gradients, enabling automatic semantic optimization from local cellular context to broader tissue morphology without fine-tuning MLLM weights. On representative HER2 and CAMELYON16 regions, SLMP improves tile-level tumor description accuracy in settings spanning general-purpose and pathology-specialized backbones, with gains of +3.3 to +19.6 percentage points. Random-neighbor ablations confirm that these gains stem from spatial context rather than additional text alone, and inspecting the optimized policies reveals interpretable, tissue-specific decision rules. Besides, without any weight updates or fine-tuning the backbone MLLM, SLMP substantially improves general-purpose MLLMs and narrows its gap to pathology-specialized counterparts, offering a transparent and flexible mechanism for incorporating spatial reasoning into MLLM-based pathology analysis.