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MacTeX-2009 installs updated versions of the GUI applications that were already in MacTeX-2008. In addition, MacTeX-2009 installs another front end named TeXworks; see TeXworks for details.
MacTeX has optional packages to install two font collections (Latin Modern and TeX Gyre) in /Library/Fonts; these TeX fonts are already in TeX Live, but installing them in /Library/Fonts makes them available to standard Macintosh applications like Adobe Illustrator. By default, these fonts are not installed.
MacTeX installs the latest version of Ghostscript, 8.70, and an updated "Convert" from ImageMagick 6.5.8. These packages are self-contained; MacTeX installs no libraries in /usr/local/lib.
MacTeX-2009 installs a completely unmodified copy of the full TeX Live 2009 distribution. This is exactly the same distribution that runs on OS X, Windows, GNU/Linux, various BSD Unix systems, and other systems.
TeX Live 2009 is a major update of TeX Live 2008. Here are some of the new features: