Video multimodal large language models support language guided video segmentation, but they often show spatio temporal inconsistencies, e.g., jitter, drift, and identity switches. These failures are more common when targets are partly hidden or when similar objects appear nearby.One likely reason is that current training lacks explicit spatial priors, which makes it difficult to maintain stable spatial identity and shape over time. We present PhysMLLMs, a training-stage prior injection architecture that injects physics-inspired spatial continuity priors into Video MLLMs. PhysMLLMs is designed to encourage more stable object-centered representations by aligning the student global visual representation with a frozen teacher model during training. Our core mechanism, Global Representation Prior Alignment (REPA-Global), distills global visual representations from a frozen DINOv2 teacher using an offline embedding cache and a scheduled distillation plan. This design keeps inference unchanged and does not add inference time cost. Across multiple video benchmarks, PhysMLLMs improves video segmentation mask quality and cross-frame consistency, with larger gains on challenging cases involving small targets, fast motion, occlusion, distractors, and reasoning queries. On single-frame referring image segmentation and representative general VLM benchmarks, PhysMLLMs maintains comparable performance, demonstrating that the injected spatial prior improves video consistency without compromising image-level grounding or general multimodal capability. These results suggest that physics-inspired spatial prior injection can improve temporal stability while preserving general capability. The code is available at https://github.com/tusu-code/20260121-icml2026-2.git.
Detecting anatomical structures in surgical video is essential for intraoperative safety frameworks such as the Critical View of Myopectineal Orifice (CVMPO) in inguinal hernia repair. While prominent structures like the Cooper's Ligament and Triangle of Doom are reliably detected by standard methods, smaller structures such as the epigastric vessels remain challenging due to their visual ambiguity and intermittent visibility. We observe that the spatial relationship between structures is anatomically constrained, and propose a Gaussian Spatial Prior (GSP) module that encodes this relationship as a compact, parametric bias injected into the self-attention of a DAB-DETR decoder. The prior is computed offline from training annotations as a small set of frozen Gaussian parameters and recomputed at each decoder layer using the iteratively refined reference points. On a dataset of inguinal hernia repair videos with 5-fold cross-validation, GSP improves dependent class detection by $+33.5\%$ ($\text{AP}_{50}$) over DAB-DETR and $+53.9\%$ over YOLOv26, while also improving anchor detection by $+6.0\%$. These gains are statistically significant across all folds ($p=0.012$, paired $t-$test).
Predicting microsatellite instability (MSI) status from routine hematoxylin and eosin (H&E) whole slide images (WSIs) offers a practical alternative to molecular testing, but models trained at one institution tend to generalize poorly to slides acquired at a different site. Foundation model representations, despite their generality, still encode site-specific texture alongside the conserved biological morphology underlying MSI. We investigate whether tile-level spatial priors derived from known MSI histology can guide these representations toward more site-invariant features. We introduce a biologically motivated spatial prior based on peripheral distance encoding, reflecting the Crohn's-like peripheral lymphocytic reaction at the tumor invasive margin, and evaluate a secondary local immune neighborhood encoding reflecting the lymphocyte-to-tumor ratio in each tile's immediate spatial neighborhood. Both priors are injected into a TransMIL aggregator before self-attention, allowing the transformer to integrate spatial biological context with UNI2-h or Virchow2 features across all attention layers. We evaluate six foundation model and MIL aggregator combinations as a reference, then assess the effect of each spatial prior. Training on TCGA-COAD (137 slides) and evaluating externally on TCGA-READ (50 slides) without retraining, peripheral distance encoding achieves MSI AUC 0.959 +/- 0.012 on COAD and MSS specificity 1.000 on READ, compared to 0.957 and 0.939 for the strongest reference configuration. Local immune neighborhood encoding achieves comparable internal AUC but lower cross-site specificity, suggesting margin proximity encodes a more site-invariant biological signal than local immune density. Results suggest biologically grounded spatial priors act as regularizers that reduce reliance on site-specific imaging patterns.