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Finely grate the garlic into a large Dutch oven or skillet. Add the olive oil and tomato paste and set over medium-high heat. When it sizzles, stir until the oil is a rusty red, 1 to 2 minutes. Add the sausage, breaking it into small pieces. Cook, stirring occasionally, until the sausage is starting to crisp, 8 to 10 minutes.

Stir in the tomatoes. (If using whole tomatoes, break them up with your spoon.) Season with salt and pepper and scrape up the browned bits from the bottom of the pot. Simmer over medium until thickened, 10 to 15 minutes.

Stir in the tortellini, cover and cook until tender, 7 to 10 minutes, stirring halfway through and scraping any that might be stuck to the bottom of the pot. If the sauce looks dry, add 1/4 cup water. Season to taste with salt and pepper and serve topped with Parmesan.

If you’d like a melted-cheese top like a baked pasta, heat the broiler with a rack in the upper third of the oven. Sprinkle the tortellini with the mozzarella. Broil until melted and browned in spots, 2 to 4 minutes.

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