Princess Quest: Mahjong Sword is a medieval-themed, story-driven mahjong game. On the continent of Audores, princesses of various countries and other noble ladies compete in the game of mahjong, trying to gain possession of the sacred titular sword. The player takes control of the young warrior Rutia, who must defeat five opponents on her way to glory.
Mahjong matches follow the typical one-on-one scheme, but the results are presented as battles, with animated attacks and hit points depleted. Money gained from winning mahjong games is spent in the shops on items that can be later used before a mahjong match for various bonuses.
Opponents also undress when losing a mahjong game. The computer version has scenes with explicit nudity as well as torture at those points. The PC Engine (TurboGrafx) CD version only displays scantily clad women, removing nudity and torture scenes.