Clinically-Informed Modeling for Pediatric Brain Tumor Classification from Whole-Slide Histopathology Images

Accurate diagnosis of pediatric brain tumors, starting with histopathology, presents unique challenges for deep learning, including severe data scarcity, class imbalance, and fine-grained morphologic overlap across diagnostically distinct subtypes. While pathology foundation models have advanced patch-level representation learning, their effective adaptation to weakly supervised pediatric brain tumor classification under limited data remains underexplored. In this work, we introduce an expert-guided contrastive fine-tuning framework for pediatric brain tumor diagnosis from whole-slide images (WSI). Our approach integrates contrastive learning into slide-level multiple instance learning (MIL) to explicitly regularize the geometry of slide-level representations during downstream fine-tuning. We propose both a general supervised contrastive setting and an expert-guided variant that incorporates clinically informed hard negatives targeting diagnostically confusable subtypes. Through comprehensive experiments on pediatric brain tumor WSI classification under realistic low-sample and class-imbalanced conditions, we demonstrate that contrastive fine-tuning yields measurable improvements in fine-grained diagnostic distinctions. Our experimental analyses reveal complementary strengths across different contrastive strategies, with expert-guided hard negatives promoting more compact intra-class representations and improved inter-class separation. This work highlights the importance of explicitly shaping slide-level representations for robust fine-grained classification in data-scarce pediatric pathology settings.

Benchmarking Multi-turn Medical Diagnosis: Hold, Lure, and Self-Correction

Large language models (LLMs) achieve high accuracy in medical diagnosis when all clinical information is provided in a single turn, yet how they behave under multi-turn evidence accumulation closer to real clinical reasoning remains unexplored. We introduce MINT (Medical Incremental N-Turn Benchmark), a high-fidelity, multi-turn medical diagnosis benchmark comprising 1,035 cases with clinically labeled evidence shards, controlled turn granularity, and information-preserving decomposition. Through systematic evaluation of 11 LLMs on MINT, we uncover three persistent behavioral patterns that significantly impact diagnostic decisions: (1) intent to answer, models rush to answer before sufficient evidence has been observed, with over 55% of answers committed within the first two turns; (2) self-correction, incorrect-to-correct answer revisions occur at up to 10.6 times the rate of correct-to-incorrect flips, revealing a latent capacity for self-correction that premature commitment forecloses; and (3) strong lures, clinically salient information such as laboratory results trigger premature answering even when models are explicitly instructed to wait. We translate these findings into clinically actionable guidance: deferring the diagnostic question to later turns reduces premature answering and improves accuracy at the first point of commitment by up to 62.6%, while reserving salient clinical evidence for later turns prevents a catastrophic accuracy drop of up to 23.3% caused by premature commitment. Our work provides both a controlled evaluation framework and concrete recommendations for improving the reliability of LLMs in multi-turn medical diagnosis.

PRIME: Prototype-Driven Multimodal Pretraining for Cancer Prognosis with Missing Modalities

Multimodal self-supervised pretraining offers a promising route to cancer prognosis by integrating histopathology whole-slide images, gene expression, and pathology reports, yet most existing approaches require fully paired and complete inputs. In practice, clinical cohorts are fragmented and often miss one or more modalities, limiting both supervised fusion and scalable multimodal pretraining. We propose PRIME, a missing-aware multimodal self-supervised pretraining framework that learns robust and transferable representations from partially observed cohorts. PRIME maps heterogeneous modality embeddings into a unified token space and introduces a shared prototype memory bank for latent-space semantic imputation via patient-level consensus retrieval, producing structurally aligned tokens without reconstructing raw signals. Two complementary pretraining objectives: inter-modality alignment and post-fusion consistency under structured missingness augmentation, jointly learn representations that remain predictive under arbitrary modality subsets. We evaluate PRIME on The Cancer Genome Atlas with label-free pretraining on 32 cancer types and downstream 5-fold evaluation on five cohorts across overall survival prediction, 3-year mortality classification, and 3-year recurrence classification. PRIME achieves the best macro-average performance among all compared methods, reaching 0.653 C-index, 0.689 AUROC, and 0.637 AUROC on the three tasks, respectively, while improving robustness under test-time missingness and supporting parameter-efficient and label-efficient adaptation. These results support missing-aware multimodal pretraining as a practical strategy for prognosis modeling in fragmented clinical data settings.

Understanding the Role of Hallucination in Reinforcement Post-Training of Multimodal Reasoning Models

The recent success of reinforcement learning (RL) in large reasoning models has inspired the growing adoption of RL for post-training Multimodal Large Language Models (MLLMs) to enhance their visual reasoning capabilities. Although many studies have reported improved performance, it remains unclear whether RL training truly enables models to learn from visual information. In this work, we propose the Hallucination-as-Cue Framework, an analytical framework designed to investigate the effects of RL-based post-training on multimodal reasoning models from the perspective of model hallucination. Specifically, we introduce hallucination-inductive, modality-specific corruptions that remove or replace essential information required to derive correct answers, thereby forcing the model to reason by hallucination. By applying these corruptions during both training and evaluation, our framework provides a unique perspective for diagnosing RL training dynamics and understanding the intrinsic properties of datasets. Through extensive experiments and analyses across multiple multimodal reasoning benchmarks, we reveal that the role of model hallucination for RL-training is more significant than previously recognized. For instance, we find that RL post-training under purely hallucination-inductive settings can still significantly improve models' reasoning performance, and in some cases even outperform standard training. These findings challenge prevailing assumptions about MLLM reasoning training and motivate the development of more modality-aware RL-based training designs.

LangMARL: Natural Language Multi-Agent Reinforcement Learning

Large language model (LLM) agents struggle to autonomously evolve coordination strategies in dynamic environments, largely because coarse global outcomes obscure the causal signals needed for local policy refinement. We identify this bottleneck as a multi-agent credit assignment problem, which has long been studied in classical multi-agent reinforcement learning (MARL) but remains underaddressed in LLM-based systems. Building on this observation, we propose LangMARL, a framework that brings credit assignment and policy gradient evolution from cooperative MARL into the language space. LangMARL introduces agent-level language credit assignment, pioneers gradient evolution in language space for policy improvement, and summarizes task-relevant causal relations from replayed trajectories to provide dense feedback and improve convergence under sparse rewards. Extensive experiments across diverse cooperative multi-agent tasks demonstrate improved sample efficiency, interpretability, and strong generalization.

Chimera: Latency- and Performance-Aware Multi-agent Serving for Heterogeneous LLMs

Multi-agent applications often execute complex tasks as multi-stage workflows, where each stage is an LLM call whose output becomes part of context for subsequent steps. Existing LLM serving systems largely assume homogeneous clusters with identical model replicas. This design overlooks the potential of heterogeneous deployments, where models of different sizes and capabilities enable finer trade-offs between latency and performance. However, heterogeneity introduces new challenges in scheduling across models with diverse throughput and performance. We present Chimera, a predictive scheduling system for multi-agent workflow serving on heterogeneous LLM clusters that jointly improves end-to-end latency and task performance. Chimera applies semantic routing to estimate per-model confidence scores for each request, predicts the total remaining output length of the workflow, and estimates per-model congestion using in-flight predicted token volumes for load balancing. We evaluate Chimera on representative agentic workflows for code generation and math reasoning using multiple heterogeneous LLM configurations. Across comparable settings, Chimera traces the best latency-performance frontier, reducing end-to-end latency by 1.2--2.4$\times$ and improving task performance by 8.0-9.5 percentage points on average over competitive baselines including vLLM.

Tabular LLMs for Interpretable Few-Shot Alzheimer's Disease Prediction with Multimodal Biomedical Data

Accurate diagnosis of Alzheimer's disease (AD) requires handling tabular biomarker data, yet such data are often small and incomplete, where deep learning models frequently fail to outperform classical methods. Pretrained large language models (LLMs) offer few-shot generalization, structured reasoning, and interpretable outputs, providing a powerful paradigm shift for clinical prediction. We propose TAP-GPT Tabular Alzheimer's Prediction GPT, a domain-adapted tabular LLM framework built on TableGPT2 and fine-tuned for few-shot AD classification using tabular prompts rather than plain texts. We evaluate TAP-GPT across four ADNI-derived datasets, including QT-PAD biomarkers and region-level structural MRI, amyloid PET, and tau PET for binary AD classification. Across multimodal and unimodal settings, TAP-GPT improves upon its backbone models and outperforms traditional machine learning baselines in the few-shot setting while remaining competitive with state-of-the-art general-purpose LLMs. We show that feature selection mitigates degradation in high-dimensional inputs and that TAP-GPT maintains stable performance under simulated and real-world missingness without imputation. Additionally, TAP-GPT produces structured, modality-aware reasoning aligned with established AD biology and shows greater stability under self-reflection, supporting its use in iterative multi-agent systems. To our knowledge, this is the first systematic application of a tabular-specialized LLM to multimodal biomarker-based AD prediction, demonstrating that such pretrained models can effectively address structured clinical prediction tasks and laying the foundation for tabular LLM-driven multi-agent clinical decision-support systems. The source code is publicly available on GitHub: https://github.com/sophie-kearney/TAP-GPT.

Farther the Shift, Sparser the Representation: Analyzing OOD Mechanisms in LLMs

In this work, we investigate how Large Language Models (LLMs) adapt their internal representations when encountering inputs of increasing difficulty, quantified as the degree of out-of-distribution (OOD) shift. We reveal a consistent and quantifiable phenomenon: as task difficulty increases, whether through harder reasoning questions, longer contexts, or adding answer choices, the last hidden states of LLMs become substantially sparser. In short, \textbf{\textit{the farther the shift, the sparser the representations}}. This sparsity--difficulty relation is observable across diverse models and domains, suggesting that language models respond to unfamiliar or complex inputs by concentrating computation into specialized subspaces in the last hidden state. Through a series of controlled analyses with a learning dynamic explanation, we demonstrate that this sparsity is not incidental but an adaptive mechanism for stabilizing reasoning under OOD. Leveraging this insight, we design \textit{Sparsity-Guided Curriculum In-Context Learning (SG-ICL)}, a strategy that explicitly uses representation sparsity to schedule few-shot demonstrations, leading to considerable performance enhancements. Our study provides new mechanistic insights into how LLMs internalize OOD challenges. The source code is available at the URL: https://github.com/MingyuJ666/sparsityLLM.

PathMoE: Interpretable Multimodal Interaction Experts for Pediatric Brain Tumor Classification

Accurate classification of pediatric central nervous system tumors remains challenging due to histological complexity and limited training data. While pathology foundation models have advanced whole-slide image (WSI) analysis, they often fail to leverage the rich, complementary information found in clinical text and tissue microarchitecture. To this end, we propose PathMoE, an interpretable multimodal framework that integrates H\&E slides, pathology reports, and nuclei-level cell graphs via an interaction-aware mixture-of-experts architecture built on state-of-the-art foundation models for each modality. By training specialized experts to capture modality uniqueness, redundancy, and synergy, PathMoE employs an input-dependent gating mechanism that dynamically weights these interactions, providing sample-level interpretability. We evaluate our framework on two dataset-specific classification tasks on an internal pediatric brain tumor dataset (PBT) and external TCGA datasets. PathMoE improves macro-F1 from 0.762 to 0.799 (+0.037) on PBT when integrating WSI, text, and graph modalities; on TCGA, augmenting WSI with graph knowledge improves macro-F1 from 0.668 to 0.709 (+0.041). These results demonstrate significant performance gains over state-of-the-art image-only baselines while revealing the specific modality interactions driving individual predictions. This interpretability is particularly critical for rare tumor subtypes, where transparent model reasoning is essential for clinical trust and diagnostic validation.

Why Diffusion Language Models Struggle with Truly Parallel (Non-Autoregressive) Decoding?

Diffusion Language Models (DLMs) are often advertised as enabling parallel token generation, yet practical fast DLMs frequently converge to left-to-right, autoregressive (AR)-like decoding dynamics. In contrast, genuinely non-AR generation is promising because it removes AR's sequential bottleneck, better exploiting parallel hardware to reduce synchronization/communication overhead and improve latency scaling with output length. We argue that a primary driver of AR-like decoding is a mismatch between DLM objectives and the highly sequential structure of widely used training data, including standard pretraining corpora and long chain-of-thought (CoT) supervision. Motivated by this diagnosis, we propose NAP (Non-Autoregressive Parallel DLMs), a proof-of-concept, data-centric approach that better aligns supervision with non-AR parallel decoding. NAP curates examples as multiple independent reasoning trajectories and couples them with a parallel-forced decoding strategy that encourages multi-token parallel updates. Across math reasoning benchmarks, NAP yields stronger performance under parallel decoding than DLMs trained on standard long CoT data, with gains growing as parallelism increases. Our results suggest that revisiting data and supervision is a principled direction for mitigating AR-like behavior and moving toward genuinely non-autoregressive parallel generation in DLMs. Our code is available at https://github.com/pixeli99/NAP.