STREAM: Stochastic Riemannian Flow Matching with Anisotropic Decoder for Digital Histopathology Image Generation

Synthetic histopathology image generation addresses critical challenges in computational pathology, including patient privacy and the growing need for large-scale training data for foundation models. Latent diffusion models have dominated the image generation domain, with recent works emphasizing that the choice of latent space is critical to the quality of generated images. Existing state-of-the-art generative models in histopathology use pretrained Vision Foundation Models (VFMs) as conditioning signals, and we observe that this leads to ``conditioning collapse'', where the conditioning signal dominates the latent space and lowers the quality and diversity of generated samples. Therefore, we instead use pretrained histopathology VFMs as the latent space itself, leveraging their patch-token features that encode rich semantic information. We empirically show that these features are $\ell_2$-normalized and lie on the unit hypersphere $\mathcal{S}^{d-1}$ with strong angular dominance and intrinsic curvature, making them naturally suited for a Riemannian formulation. We therefore present STREAM, the first framework to apply Riemannian flow matching in the pathology domain. STREAM consists of two stages: 1) a bridge-type stochastic perturbation that establishes per-token rectifiability on $\mathcal{S}^{d-1}$ for training a Diffusion Transformer (DiT) in latent space, and 2) a novel anisotropic decoder that allocates robustness to data-sparse directions while preserving fidelity along data-dense ones. Together, STREAM achieves state-of-the-art reconstruction and generation performance on breast and colorectal cancer datasets.