With a shape that resembles a seashell, it is easy to see how the locals in the seaside communities of Naples and Genoa got their inspiration in the creation of Medium Shells, or Mezzo Conchiglie. Its graceful, concave shape is covered in ridges. Medium Shells are used widely in American-inspired pasta salads, and in the American favorite macaroni & cheese. Traditional Italian usage might include dairy-based sauces, tomato-based sauces, pasta salads, and meat sauces.