Bring a large pot of lightly salted water to a boil; add the macaroni and cook until al dente, 8 to 10 minutes; drain.
Crumble the sausage into a large, deep skillet over medium heat; cook and stir the sausage until completely browned, 5 to 7 minutes.
Combine the cooked sausage, tomatoes, broth, mushrooms, butter, pepperoni, onion powder, garlic powder, and pepper in a large pot over medium heat and simmer 50 minutes; add the cooked macaroni and cook another 10 minutes. Sprinkle with Parmesan cheese to serve.
