A Patient’s Story: Walking Down the Aisle After a Lifesaving 14-hour Complex Surgery

In April 2023, when Ariana Pulido was on her way to Las Vegas, Nevada, to meet her boyfriend, she felt a deep stomach cramp. She brushed it off. But two days later, on her way back home to Oxnard, California, the pain became unbearable.

A CT scan at Pulido’s community hospital revealed a large tumor on Pulido’s right ovary—roughly the size of a small basketball. Surgeons removed the cancerous mass, only to discover a smaller tumor on the left ovary, which was removed three months later.

Believing the worst was behind her, Pulido returned to work. But her sense of normalcy was short-lived. Within a month, sharp pains returned.

“I was getting the worst shoulder pain I could get on my left side,” Pulido said.

“I went back to the emergency room, and they did another CT scan. Then they saw another tumor. It was much bigger than the first one,” she added.

A diagnoses
The doctors diagnosed Pulido—just 22 years old— with a rare condition known as growing teratoma syndrome (GTS). The condition occurs in patients with non-seminomatous germ cell tumors (NSGCT) characterized by tumor tissue which continues to metastasize rapidly and uncontrollably, pressing on vital organs like the heart, liver and lungs. [1]

Although the disease was first identified in 1969 and reported by DW Smithers from Royal Cancer Hospital, London as benign maturation, it took until 1982 when Logothetis and colleagues at the University of Texas MD Anderson Cancer Center, Houston, Texas, named and described the disease entity as known to us today – characterized by a benign metastasis which increases in size and number during or after completion of chemotherapy.[1]

Being a chemo and radio-resistant disease, surgery is the only cure.  And while prognostic is excellent after the resection, surgical excision of large growing teratoma syndrome lesions, such as in Pulido’s case, is technically challenging and serious intraoperative complications may occur[1][2][3]

To date, the exact etiology of growing teratoma syndrome remains unclear and there is no single genetic or environment factor that has been implicated in the development of the disease. And while the development of growing teratoma syndrome had been reported with every chemotherapeutic agent that is used in treatment of germ cell tumor, including  bleomycin, etoposide, csplatin, methotrexate, actinomycin D, and cyclophosphamide, there is, in fact, no clear evidence that a single chemotherapeutic agent is associated with an increased incidence of the disease.[1][4]

Because growing teratoma syndrome is a rare and infrequent condition, not every oncologists is familiar with the disease and may, as a result, misinterpret it as disease progression, rather than a separate disease. This often leads to delay in diagnosis and surgical intervention which in turn may lead to an increase in complications. [1]

Large and heavy
Pulido’s story took a grim turn when the third and largest tumor, about 14 centimeters, was located near her liver. Doctors recommended chemotherapy to shrink the tumor, but it failed, and the mass kept growing at an alarming rate. The tumor had progressed so much in size that it was pressing up against her right lung, shifting her heart to the far-left side, essentially under Pulido’s armpit.

By May 2024, the tumor had reached 27 centimeters, weighed more than 40 pounds, and left her wheelchair-bound and dependent on oxygen.

A High-Stakes Surgery Despite the Risks
When chemotherapy failed, surgically removing the tumor was the inevitable choice. After multiple surgery delays and six failed attempts to put Pulido under anesthesia, her original care team halted the procedure altogether.

“The doctors came out of the surgery and told my mom they couldn’t move forward with the surgery because I couldn’t go under anesthesia without flat-lining,” Pulido said.

“They said the next best step for me would be hospice care,” she added.

Still, Pulido and her family refused to give up.

In their last push for hope, her family sought several opinions from various institutions, but ultimately chose to seek care from Cristina Ferrone, MD, chair of the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai in Los Angeles, California.

Ferrone quickly assembled a team of experienced anesthesiologists and 13 surgeons from various specialties, including cardiothoracic and liver transplant teams, to perform the complex surgery.

“The tumor was so large and heavy, and it involved such essential blood vessels that if you injure them, it would be very, very difficult to repair them. And an injury like that could quickly lead to death on the operating room table,” Ferrone explained.

Yet, Pulido was willing to take her chances.

“The only one that could decide if I do go or stay on that surgery table would be God,” Pulido said.

“And I just had really high hopes and faith that I was going to make it through,” she continued.

Awake on the Operating Table
The surgical team included Tyler Gunn, MD, an assistant professor of Cardiac Surgery at Smidt Heart Institute at Cedars-Sinai. During the first half of the surgery, Gunn performed a critical procedure called preoperative extracorporeal membrane oxygenation, or ECMO, using only local anesthesia while Pulido was still awake in order to keep her respiration and heartbeat stable and to stop her from flat-lining.

“When someone goes to sleep for surgery, their muscle tone decreases and the blood flow to the heart can decrease as well. And they can have trouble with their blood pressure, breathing and heart rate,” Gunn said.

Furthermore, as Pulido’s heart was unstable, lying flat on the operating table was not an option. To work around this, the team placed Pulido on an incline for the first half of the surgery.

“In my mind, I just kept saying, ‘You got this, just keep fighting, keep pushing,’” Pulido said.

The long, arduous surgery was a success.

“In the end, we spent over 14 hours operating with all of the different teams working together,” Ferrone said. “It’s a testament to the working environment of Cedars-Sinai. It is an incredibly collaborative institution and patient care comes first, no matter what.”

Within a week after the tumor removal, Pulido’s lungs were able to fully expand, and her heart was back in its rightful place. She was able to breathe on her own for the first time in six months.

From Wheelchair to Walking Down the Aisle
Amid her harrowing healthcare journey, Pulido found a few uplifting moments, including an important life milestone. Last year, during the halftime show on Super Bowl Sunday, her longtime boyfriend, Jeffrey Chavez, who had stood by her through every challenge, surprised her with a proposal.

“He was always there every day with me, whether it was before work, after work, he was there and visiting me all the time at my mom’s house,” Pulido said.

For Ferrone, watching Pulido through her demanding recovery process has been incredibly gratifying.

“When she returned to the clinic a month later, the entire staff and I were amazed. Just six weeks earlier, she had been wheeled in, in a wheelchair. Now she walked through the doors,” Ferrone said. “She’s an incredibly strong young woman and has a wonderfully supportive family.”

On June 21, a little over a year after her life-changing surgery, Pulido walked down the aisle and tied the knot with Chavez in front of her close family and friends. While Pulido will need to continue to monitor her health closely, the newlywed is hopeful and looks forward to the next phase of life.

“I feel really good. I feel like a new person. I see the world differently,” Pulido said. “Every day is a positive day.”

Reference
[1] Kataria SP, Varshney AN, Nagar M, Mandal AK, Jha V. Growing Teratoma Syndrome. Indian J Surg Oncol. 2017 Mar;8(1):46-50. doi: 10.1007/s13193-016-0568-3. Epub 2016 Oct 27. PMID: 28127182; PMCID: PMC5236020.
[2] Logothetis CJ, Samuels ML, Trindade A, Johnson DE. The growing teratoma syndrome. Cancer. 1982 Oct 15;50(8):1629-35. doi: 10.1002/1097-0142(19821015)50:8<1629::aid-cncr2820500828>3.0.co;2-1. PMID: 6288220.
[3] Dusaud M, Durand X, Lahutte M, Desfemmes FR, Vedrine L, Houlgatte A. Le growing teratoma syndrome [Growing teratoma syndrome]. Prog Urol. 2012 Sep;22(10):568-71. French. doi: 10.1016/j.purol.2012.04.001. Epub 2012 May 31. PMID: 22920334.
[4] Gorbatiy V, Spiess PE, Pisters LL. The growing teratoma syndrome: Current review of the literature. Indian J Urol. 2009 Apr;25(2):186-9. doi: 10.4103/0970-1591.52910. PMID: 19672343; PMCID: PMC2710061.

Featured image: Ariana Pulido (right) and Jeffrey Chavez cut the cake at their wedding. Photo courtesy: © 2025 Ariana Pulido. Used with permission.

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