Accurate analysis of pathological images is essential for automated tumor diagnosis but remains challenging due to high structural similarity and subtle morphological variations in tissue images. Current vision-language (VL) models often struggle to capture the complex reasoning required for interpreting structured pathological reports. To address these limitations, we propose PathoHR-Bench, a novel benchmark designed to evaluate VL models’ abilities in hierarchical semantic understanding and compositional reasoning within the pathology domain. Results of this benchmark reveal that existing VL models fail to effectively model intricate cross-modal relationships, hence limiting their applicability in clinical setting. To overcome this, we further introduce a pathology-specific VL training scheme that generates enhanced and perturbed samples for multimodal contrastive learning. Experimental evaluations demonstrate that our approach achieves state-of-the-art performance on PathoHR-Bench and six additional pathology datasets, highlighting its effectiveness in fine-grained pathology representation.

While Multimodal Large Language Models (MLLMs) have achieved remarkable progress in open-ended visual question answering, they remain vulnerable to hallucinations. These are outputs that contradict or misrepresent input semantics, posing a critical challenge to the reliability and factual consistency. Existing methods often rely on external verification or post-hoc correction, lacking an internal mechanism to validate outputs directly during training. To bridge this gap, we propose ReLoop, a unified closed-loop training framework that encourages multimodal consistency for cross-modal understanding in MLLMs. ReLoop adopts a ring-shaped structure that integrates three complementary consistency feedback mechanisms, obliging MLLMs to “seeing twice and thinking backwards”. Specifically, ReLoop employs the frozen Consistency Feedback Plugin (CFP), comprising semantic reconstruction, visual description, and an attention supervision module for attention alignment. These components collectively enforce semantic reversibility, visual consistency, and interpretable attention, enabling the model to correct its outputs during training. Extensive evaluations and analyses demonstrate the effectiveness of ReLoop in reducing hallucination rates across multiple benchmarks, establishing a robust method for hallucination mitigation in MLLMs. We will release our source code and data in the camera-ready version. The code is available at: https://github.com/ZiyanHuang11/Reloop-hallucinations.