In a large saucepan combine water, vegetable soup, mixed vegetables, and Italian seasoning. Bring to boiling. Add uncooked shell macaroni and cook, covered, for 5 minutes.
Drop the meat by spoonfuls into the sauce mixture (Or, form meat into 3/4-inch balls and add to stew). Return to boiling. Reduce heat. Cover and simmer for 12 to 14 minutes or until meatballs are done and macaroni is just tender. Top each serving with cheese, if desired. Makes 4 servings.