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Preheat oven to 375 degrees F.
In a large skillet, sauté onion and green pepper in butter over medium heat until tender. Add ground round, cooking until brown. Add salt, pepper, oregano and Worcestershire sauce.
In a 2 1/2-quart casserole, combine cooked macaroni, ground round mixture, mushrooms, soup and chopped tomato. Cover and bake for 40 minutes.
Remove from oven; sprinkle cheese on top and bake 5 minutes longer, or until cheese is melted and brown.
Makes 4 to 6 servings.