The authors agree that the surname presents two main hypotheses of origin. The first links it to a nickname derived from a Renaissance term related to weapons or household utensils; the second connects it with the medieval name Pisto, in the genitive Pistonis.

E. Rossoni notes that the term in question would be pistone in the sense of a type of musket, which would suggest that the first bearer of the surname practised the trade of soldier. Rossoni also mentions the possibility of a toponymic origin and documents the notary Matteo Pistone in Caltagirone during the 15th century, who took part in a deed of sale of a work by the painter Antonello da Messina.

F. Miranda agrees with the musket hypothesis and that of the medieval name Pisto-Pistonis, without deciding for either as definitive. Miranda adds that the surname is distributed in two main areas: Sicily —with a presence in the Catania, Messina, Caltanissetta and Enna areas— and the region of Piedmont together with Liguria, besides a smaller presence in Campania, Lazio, Tuscany and Basilicata, among others.

V. Blunda offers a different perspective from Sicilian dialectology: he derives the surname from the dialect word pistùni, which designates the mallet or wooden or stone pestle used to grind spices and grains. In this case, the nickname would have alluded to a person of robust build or firm blow, and its use would have remained restricted to Sicily.